Head Trauma Patients Research Articles

Factors determining the requirement of surgical intervention and prognosis in cases of traumatic bifrontal contusions: A prospective observational study

Background: Traumatic brain injury, being a notorious cause of mortality and morbidity across the globe, presents with a variety of lesions. One of the distinct patterns of injury is characterized by contusions of both frontal lobes, labeled “traumatic bifrontal contusions” (TBCs). TBC is often associated with the presence of significant edema and mass effect leading to rapid clinical deterioration after a usually benign presentation at the time of first evaluation. Formulating a management plan in a patient with TBC is often more difficult than in a patient with a major intracranial hematoma. Methods: A prospective observational study with aims and objectives to identify predictors of an unfavorable outcome, analysis of the evolution of TBC, evaluation of the specific indications for surgery, and determination of the prognosis. All head trauma patients harboring bifrontal contusions were included in the study. Patients with other associated operable injuries involving blunt trauma abdomen and orthopedic injuries, counter-coupe injuries, and obvious open fractures noted over calvaria were excluded from the study. Glasgow coma scale (GCS) was recorded during the first assessment, followed by non-contrast computerized tomography (NCCT) Head. Results: A total of 53 patients satisfying inclusion and exclusion criteria were included in the study. The average GCS score recorded before surgical intervention was 9. The mean and median best motor response noted was M5. The interval from the time of injury to the first NCCT of the brain at the study hospital ranged from 3 h to 163 h, averaging 17.66 h. The median category w.r.t Marshall’s CT classification observed was “Diffuse Injury IV.” The volume of the contusions in each scan was estimated, and the average anterior cranial fossa volume observed was 125 mL. “Upfront surgery” (“Bifrontal decompressive craniectomy” or “unilateral Fronto-Temporo-Parietal [FTP] decompressive hemicraniectomy”) was carried out on the day of admission based on the findings on the first NCCT brain. About 49% of patients at presentation needed surgical intervention as per existing protocols. The duration of observation for patients who were initially observed but eventually had to undergo surgery ranged from 1 to 5 days, with an average observation period of 2 days. The duration of observation in those who did not subsequently need surgery ranged from 7 to 10 days, with an average duration of 9 days. Conclusion: What leads to the poorly predictable, delayed, and rapid deterioration that sets TBCs apart from other traumatic brain injuries is still unclear. Our study finds that having a low threshold for repeat CT imaging of the patient led to earlier identification of progression, and a low threshold for surgical intervention led to favorable outcomes.

Clinical characteristics and functional outcome of surgically treated adult head trauma patients with acute subdural hematoma: Ethiopian tertiary hospitals experience

BackgroundAcute subdural hematoma (ASDH) is one of the most common and devastating lesions in traumatic brain injury with a mortality rate upto 60 % especially in low-income countries. The present study aimed to determine the clinical characteristics and functional outcomes and the associated factors of surgically treated head trauma patients with ASDH. MethodsBetween January 2018 and January 2021 we identified 140 head trauma patients with ASDH who underwent surgical evacuation in three tertiary hospitals. Epidemiological data were collected; the six-month functional outcome was studied using an extended Glasgow outcome score (EGOS) and associated factors were also studied. Univariate analysis was performed at first, and variables with a P-value of <0.05 were entered into the multivariable logistic regression model. ResultsMale predominance was seen accounting for 87 % and assault was the most common mechanism of injury (35.7 %). Sixty-five (56.5 %) of patients achieved favorable functional recovery (EGOS of 5–8) and 50 (43.5 %) of patients had unfavorable recovery (EGOS of 1–4) after 6 months of follow-up. In multivariate logistic regression models, GCS <5, Pupillary abnormality, hypotension, oxygen saturation <90 at presentation, and hospital-acquired pneumonia were the independent factors associated with unfavorable functional outcomes. ConclusionIn our setup, most of the patients are male from assault injuries. There is still a high rate of unfavorable outcomes in patients with acute subdural hematoma. GCS <5, pupillary abnormality, hypotension and desaturation at presentation, and postoperative hospital-acquired infection are predictors for unfavorable functional outcomes.

Evaluating mortality and 6-month functional outcomes of patients with dural venous sinus thrombosis in traumatic brain injury.

Patients with dural venous sinus thrombosis (DVST) in select populations following traumatic brain injury (TBI), including those with blunt mechanism or depressed skull fractures, have been shown to have an increased risk of mortality. The purpose of this study was to assess these findings in a mixed population of head trauma patients. The authors performed a case-control study using propensity score matching by reviewing 17 years (2004-2021) of data from their institutional trauma registry. Patients with imaging-confirmed DVST were matched to a control group of TBI patients without identified DVST based on age, sex, postresuscitation Glasgow Coma Scale (GCS) score, and Injury Severity Score. All age groups and injury mechanisms were included with a head Abbreviated Injury Scale score ≥ 3. Data on demographics, injury and radiographic characteristics, and patient outcomes were collected. Multivariable logistic regression was performed to identify predictors of inpatient mortality. An additional subgroup analysis of patients with concurrent DVST and blunt cerebrovascular injury (BCVI) was planned a priori. The authors identified 9875 patients who presented to their institution over the study period with TBIs, with a 1.64% incidence of DVST. Concurrent BCVI was diagnosed in 23.5% of patients with a DVST. Following matching, the presence of DVST itself was not significantly associated with inpatient mortality (OR 0.68, 95% CI 0.24-1.88). On regression analysis, penetrating injuries (8.19, 95% CI 1.21-80.0) and lower postresuscitation GCS scores (0.69, 95% CI 0.53-0.84) were independently associated with inpatient mortality for patients with traumatic DVST. Significantly worse functional outcomes were observed in those with DVST at 3 months, with no significant difference at 6 months. The authors observed a prevalence of traumatic DVST of 1.64% in a mixed population of head-injured patients, with 23.5% of patients with DVST having concurrent BCVI. Traumatic DVST alone was not associated with a significantly increased risk of inpatient mortality.

Comparison of the decompressive craniectomy results in patients with ischemic stroke and acute subdural hematoma and determination of prognostic markers

Aims: This study aimed to investigate the therapeutic effectiveness of decompressive craniectomy in patients with traumatic acute subdural hematoma and stroke patients and to determine the parameters that could predict the risk of mortality in these patients. Methods: Patients diagnosed and operated on with acute subdural hematoma (ASH) or stroke between January 2022 and September 2023 were grouped into the ASH group and the CVO group. The patients were also divided into DEAD and SURVIVED groups according to mortality. Age, gender, anisocoria, the area of the craniectomy field, length of stay in the intensive care unit (ICU), length of stay in the hospital, and Glasgow Outcome Scale scores were recorded. In addition, Glasgow Coma Scale (GCS) scores, the amount of midline shift, and the blood biochemistry results were recorded pre-and postoperatively. Results: This study consisted of 11 (5 male and 6 female) patients. Sex, preoperative GCS score, anisocoria, postoperative sedation anesthesia time, postoperative GCS score, duration of stay in the ICU, preoperative serum blood urine nitrogen, preoperative serum C-reactive protein (CRP), postoperative neutrophil-to-lymphocyte ratio, and postoperative CRP values were different between the ASH and CVO groups (p&lt;0.05). Furthermore, the preoperative GCS score, postoperative GCS score, postoperative sedation anesthesia duration, postoperative serum aspartate aminotransferase (AST), and postoperative serum CRP level values were different between the DEAD and SURVIVED groups (p&lt;0.05). The correlation analysis results revealed a positive correlation between mortality and preoperative GCS score and a negative correlation between mortality and anisocoria (p&lt;0.05). The ROC-curve analysis revealed that preoperative GCS and postoperative GCS score, postoperative midline shift, postoperative serum AST level value, and postoperative serum CRP level value could predict mortality risk (p&lt;0.05). However, Logistic Regression analysis showed that any study parameter could be used as the best marker for prediction of the postoperative mortality risk (p&gt;0.05). Conclusion: This study showed that decompressive craniectomy may offer more satisfactory results in severe head trauma patients. It was also argued that preoperative and postoperative GCS scores, postoperative midline shift values, and postoperative serum AST and CRP level values could be used to predict mortality risk.

The burden of head trauma in rural and remote North Queensland, Australia

BackgroundHead trauma is a leading cause of death and disability worldwide. Young males, Indigenous people, and rural/remote residents have been identified as high-risk populations for head trauma, however, Australian research is limited. Our aim was to define and describe the incidence, demographics, causes, prehospital interventions, and outcomes of head trauma patients transported by aeromedical services within North Queensland, Australia. We hypothesized that young, Indigenous males living remotely would be disproportionately affected by head trauma. MethodsWe conducted a retrospective study of all head trauma patients transferred by air to or between Townsville, Cairns, Mount Isa and Mackay Hospitals between January 1, 2016 and December 31, 2018. Patients were identified from the Trauma Care in the Tropics data registry and followed for a median 30-months post-injury. Primary endpoints were patient and injury characteristics. Secondary outcome measures were hospital stay and mortality. ResultsA total of 981 patients were included and 31.1 % were Indigenous. Sixty-seven percent of injuries occurred remotely and the median time from injury to hospital was 5.8-hours (range 67–3780 min). Eighty percent of severe head injuries occurred in males (p = 0.007). Indigenous and remote patients were more likely to sustain mild injuries. The most common mechanism of injury overall was vehicle accident (37.5 %), compared to assault in the Indigenous subgroup (46.6 %, p<0.001). The overall mortality rate was 4.9 %, with older age and lower initial Glasgow Coma Score significant predictors of in-hospital mortality. Prehospital intubation was associated with a 7-fold increased risk of mortality (p = 0.056), while patients that received tranexamic acid (TXA) were almost 5-times more likely to die. ConclusionsIn North Queensland, young Indigenous males are at highest risk of traumatic head injuries. Vehicle accidents are an important preventable cause of head injury in the region. TXA administration is an important consideration for remote head trauma retrievals, in which time to emergency care is prolonged. Appropriate treatment and risk stratification strategies considering time to definitive care, severity of injury, and other prehospital patient factors require further investigation.

Predictors of Outcome in Management of Paediatric Head Trauma in a Tertiary Healthcare Institution in North-Central Nigeria.

Trauma is a leading causes of death and disability in all ages. The aim of this study was to describe the demography and characteristics of paediatric head trauma in our institution and examine the predictors of outcome and incidence of injury related mortality. We examined our institutional Trauma Registry over a 2 year period. A total of 1100 trauma patients were seen over the study period. Of the 579 patients who had head injury 99 were in the paediatric age group. Of the paediatric head trauma patients 79 had documented Glasgow coma score (GCS), 38 (48.1%), 17 (21.5%) and 24 (30.4%) had mild, moderate and severe head injury respectively. The percentage mortality of head injury in the paediatric age group was 6.06% (6/99). There is an association between mortality and GCS (p=0.008), necessity for intensive care unit (ICU) admission (p=0.0001), associated burns (p=0.0001) and complications such as aspiration pneumonia (p=0.0001). The significant predictors of outcome are aspiration (p=0.004), the need for ICU admission (p=0.0001) and associated burns (p=0.005) using logistic binary regression. During the study period 46 children underwent surgical intervention with extradural haematoma 16 (34.8%), depressed skull fracture 14 (30.4%) and chronic subdural haematoma five (10.9%) being the commonest indication for surgeries. Paediatric head injury accounted for 9.0% (99/1100) of all trauma admissions. Majority of patients had mild or moderate injuries. Burns, aspiration pneumonitis and the need for ICU admission were important predictors of outcome in children with traumatic brain injury.

Use of National Institute for Health and Care Excellence head injury guidelines among patients with delayed presentation after head trauma can lead to missed traumatic brain injury: a 5-year institutional review.

In 2014, traumatic brain injury (TBI) caused 3 million ER visits, hospitalizations, and deaths in the US. The National Institute for Health and Care Excellence (NICE) guidelines, initially generated using data from patients presenting within 24h of head trauma, are used to determine the need for head computed tomography (CT) scan in patients after 24h. The authors wanted to determine the proportion of CT scans for head trauma performed at our center in late presenters (>24h after head trauma), the incidence of intracranial pathology in early (24h) versus late (>24h) presenters, and the sensitivity of the NICE guidelines for TBI in these two subpopulations. A retrospective chart review was conducted at a tertiary care center in Karachi. All people (>16) who had a head CT for head trauma from 2010 to 2015 were included. Age, sex, primary diagnosis, comorbid disorders, mechanism-of-injury, duration (in hours) from head trauma to presentation, site, and extent of injury (injury severity scale), hospital stay, number and details of surgical procedures, CT scan findings, other injuries, and mortality were recorded. Means were compared using the Independent Sample t-test, while categorical variables were compared using χ2. Multivariate logistic regression analyses were used to identify TBI predictors. The authors found 2009 eligible patients; seven were excluded due to incomplete medical records. The final statistical analysis comprised 2002 head trauma patients. Overall, 52% of early and late presenters had severe injuries, and 2.3% died. 32.2% of patients with head trauma had CT after 24h. Early presenters were 46.7% traumatized, while late presenters were 63%. The NICE guidelines were 93% sensitive for early presenters and 83% for late presenters with traumatic intracranial injury. Patients coming to the emergency department after 24h of head trauma are a large proportion of the overall head trauma population. The NICE guidelines for late-presenting head injuries are less sensitive and may overlook intracranial injuries if imaging is not performed.

PHENYTOIN AS A PROPHYLAXIS OF POST-TRAUMATIC SEIZURES IN HEAD TRAUMA PATIENTS AT JAKARTA ISLAMIC HOSPITAL CEMPAKA PUTIH IN 2020-2022

Introduction: Post-traumatic seizures can occur as a complication of head injury, whether it is immediately after the head injury to months or years after. Phenytoin is an anti-epileptic drug that has been used widely as a prophylaxis for posttraumatic seizures. Method: The study was conducted retrospectively using medical records of head trauma patients in hospitals in 2020-2022 on 54 samples treated up to seven days post-trauma. Samples were obtained which were then analyzed by medical records, looking at the patient's identity, patient diagnosis, seizure symptoms, and history of anti-seizure drugs. Result: Patients given phenytoin prophylaxis [22 (40.7%)] who did not have seizures [18 (33.3%)] were more than patients who had seizures [4 (7.4%)]. Similar results occurred in patients without phenytoin prophylaxis [32 (59.3%)], more patients with no seizures [30 (55.6%)] than those with seizures [2 (3.7%)]. Conclusion: The usage of phenytoin is still not routinely given to post-traumatic head patients at RSIJ Cempaka Putih. The administration is carried out on a case-by-case basis assessment must be carried out in determining the use of phenytoin as a seizure prophylactic so that the benefits outweigh the side effects. For further research, it is recommended to conduct an EEG examination on head trauma patients to determine the diagnosis of post-traumatic seizures/epilepsy and conduct further seizure evaluation. Keywords: Post-trauma seizure; Phenytoin; Prophylaxis; Head Trauma; Jakarta Islamic Cempaka Putih Hospital

The value of computed tomography for head trauma in patients presenting with out-of-hospital cardiac arrest before emergency percutaneous coronary intervention.

Out-of-hospital cardiac arrest (OHCA) caused by an ST-elevation myocardial infarction (STEMI) is often accompanied by asudden loss of consciousness that may cause the patient to collapse with resulting head trauma, leading to asuspicion of possible intracranial haemorrhage. To rule out intracranial haemorrhage before emergency percutaneous coronary intervention (PCI), emergency computed tomography (CT) of the head might be useful but also causes adelay in percutaneous STEMI treatment. The medical records of all adult patients that presented with OHCA to the emergency department (ED) of the University Medical Centre Utrecht (UMCU), the Netherlands between 16February 2020 and 16February 2022 were reviewed. Atotal of 263 patients presented to the ED with an OHCA; 50presented with aSTEMI requiring emergency PCI. Thirty-nine (78%) patients with aSTEMI were immediately referred to the catheterisation laboratory and 11(22%) STEMI patients underwent aCT scan prior to emergency angiography; in no case was PCI deferred on the basis of the CT findings. The dominant indication for CT of the head was collapse, reported by 10patients and resulting in avisible traumatic head injury in 7patients. In none of the patients was intracranial haemorrhage detected. However, there was adelay between presentation to the ED and arrival at the catheterisation laboratory in patients who underwent CT of the head (mean 63 ± 25 min) before emergency PCI compared to patients without aCT scan (mean 37 ± 21 min). CT of the head did not result in adiagnosis of intracranial haemorrhage or deferral of PCI but did delay PCI treatment for STEMI in patients presenting with OHCA.

Prehospital Predictors for Urgent Neurosurgical Intervention in the Head Trauma Patient: A 2-Year Multicenter Retrospective Study.

Traumatic brain injury (TBI) is the main cause of disability in the world. Prehospital diagnosis of patients requiring rapid neurosurgical intervention and the earliest possible introduction of procedures preventing secondary brain injuries (SBI) are crucial. Methodology and Study Population. The authors of this paper assumed that certain age groups with specific injuries are more likely to require urgent neurosurgical intervention compared with patients who did not require such an intervention. Out of 54,814 head CT scans, based on the inclusion criteria, 7,864 were selected for the study. Data such as sex, age, the mechanism of injury, comorbid trauma, and abnormal findings in the examination of patients qualified for urgent neurosurgical intervention were analyzed in order to find statistically significant factors through a comparison with all head trauma patients. Patients qualified for urgent neurosurgical intervention were significantly older compared with the others (63 years vs. 49 years). Patients transferred from the emergency department directly to the operating room were more often admitted to the hospital due to the fall (64.1% vs. 45.1%, p = 0.004). The following were observed much more commonly among the patients qualified for urgent neurosurgical intervention than in the entire study group of subjects with traumatic brain injury (TBI), e.g., calf deformity (2.2% vs. 0.1%, p = 0.019) and bleeding from the mouth (4.3% vs. 0.0%, p < 0.001). On the other hand, superciliary arch wounds were observed much less commonly than in the entire group (0.0% vs. 5%, p = 0.221). Patients admitted directly to the operating neurosurgical room from emergency departments constitute a small percentage of TBI patients, and their prognosis for normal performance status upon discharge is poor. Maximum efforts should be made to distinguish these patients and to start proper treatment even during prehospital care.

Timing of computed tomography imaging in adult patients with severe trauma: A nationwide cohort study in Japan

PurposeComputed tomography (CT) has become essential for the management of trauma patients. However, appropriate timing of CT acquisition remains undetermined. The purpose of this study was to assess the relationship between time to CT acquisition and mortality among adult patients with severe trauma. MethodsWe conducted a retrospective cohort study using data from the Japan Trauma Data Bank, which had 256 participating institutions from all over Japan between 2004 and 2018. Patients were categorized upon arrival as either severe trunk trauma with signs of shock or severe head trauma with coma and separately analyzed. Cases were further divided into three groups based on time elapsed between arrival at hospital and CT acquisition as immediate (0–29 min), intermediate (30–59 min), or late (≥60 min). Primary outcome was mortality on discharge, and multivariate logistic regression with adjusting for confounders was used for evaluation. ResultsA total of 8467 (3640 in immediate group, 3441 in intermediate group, 1386 in late group) with trunk trauma patients and 6762 (4367 in immediate group, 2031 in intermediate group, 364 in late group) with head trauma patients were eligible for analysis included in the trunk and head trauma groups, respectively. The trunk trauma patients with shock on hospital arrival was 56.4% (4773/8467), and the head trauma patients with deep coma upon EMS arrival was 44.2% (2988/6762). Mortality rate gradually increased from 5.7% to 15.8% with prolonged time to CT imaging among trunk trauma patients. Multivariate logistic regression for death on discharge among trunk trauma patients yielded an adjusted odds ratio of 1.79 (95% confidence interval: 1.42–2.27) for the late group compared to the immediate group. In contrast, among head trauma patients, an adjusted odds ratio was 0.93 (95% confidence interval: 0.71–1.20) for the late group compared to the immediate group. ConclusionCT scan at or after 60 min was associated with increased death on discharge among patients with severe trunk trauma but not in those with severe head trauma.

Pneumocephalous: Radiological Presentation of Intra-cranial Hypotension after Spinal Anaesthesia

Pneumocephalus is a commonly encountered entity in patients of head trauma and post-op cases of neurosurgery, however it is rarely observed after spinal anaesthesia.&#x0D; It commonly presents orthostatic hypotension associated with severe headache, nausea and vomiting. We report a case of pneumocephalus following spinal anaesthesia administered for open hernia repair.&#x0D; The proposed mechanisms of pneumocephalus secondary to spinal tapping are the ball-valve mechanism (1) and the inverted soda-bottle effect (2).

Prevalence of Subdural and Epidural Hematoma in Head Trauma Patients: A Cross-sectional Study

Background: Epidural hematoma (EDH) and subdural hematoma (SDH) are common complications after traumatic brain injury. Intracranial hematomas can be without complications or associated with life-threatening conditions, including midline shift, cerebral edema, intracerebral ischemia, and increased intracranial pressure. This study aimed to investigate the prevalence of EDH and SDH in patients with head trauma attending the emergency department. Materials and Methods: This descriptive cross-sectional study included 146 patients with head trauma referred to the Emergency Department of Shahid Mohammadi Hospital, Bandar Abbas, in 2021. Patients’ data, including age, gender, Glasgow Coma Scale (GCS) on admission, mechanism of trauma, type of hematoma, length of intensive care unit (ICU) stay, outcome (recovery/death), and neurosurgery requirements were extracted from their medical files. Results: The mean age of the participants was 20.97±15.05 years, of whom 114 (78.1%) were male. EDH and SDH were observed in 7.5% and 11% of patients, respectively. The most common mechanism of trauma was traffic accidents (39%), followed by falls (28.1%) and assaults (13%). Moreover, 11% of the patients needed neurosurgical intervention. Most patients recovered (95.9%), and 4.1% died. The mean GCS on admission was 13.47±2.34. Furthermore, SDH was significantly higher in the patients who died (P=0.001) and those aged≥18 years (P=0.028). Conclusion: The results of the current study showed a higher prevalence of SDH compared to that of EDH. Both hematoma types appeared to correlate with the mechanism of trauma, ICU admission, GCS on admission, and neurosurgery requirement, while SDH was associated with age and death.

Determining the risk of development of cranial pathology in patients with minor head injury using antiagregan-anticoagulants

Background: Patients use antiplatelet/anticoagulant drug which is increasing bleeding tendency is increasing with age. These patients can be admitted to the emergency room with minor head trauma and some ambiguities which may occur in the management of emergency services We undertook this study to determine the factor of intracranial hemorrhage in anticoagulated patients and patients on antiplatelet therapy and its impact on clinical management, identify predictors of positive imaging findings and their outcomes. Methods: ın a prospective analysis, All patients who had minor head trauma between June 1, 2014 and May 1 2015 were included in this study. They should be evaluated by doctors in the ED; no interference will be made during diagnosis and treatment. We reviwed medications, mechanism of injury, head CT results and outcomes. Demografic data, symptoms, clinical examinations were recorded. Results: 606 patients with minor head trauma were admitted to the emergency department. The average age of patients was 48.6 ± 22.6 and 57% (n = 345) were men, 43% (n = 261) were female. 30% of them (n:182) were taking antiplatelet/anticoagulant. Patients who use antiplatelet/anticoagulat is older then patients who didn’t use antiplatelet/anticoagulat therapy. Patients had CT scanned and they had 14,6% pathological finding. But this wasn’t statistically significant (p=0,762). Similarly, there was no statistically significant difference between 68 users antiplatelet and anticoagulant therapy (p = 0.865). Nausea was statistically significant in patients with pathology in the head CT (p=0,045). Conclusion: Minor head trauma in patients may die or have brain hemorrhage who use ASA with klopidogrel. However, symptoms of the patient, physical examination and laboratory data are insufficient to predict the risk of intracranial pathology.

Antikoagülan ve/veya Antiplatelet Tedavi Kullanan Hafif Kafa Travmalı Hastalarda Başlangıçta Normal olan Bilgisayarlı Kafa Tomografisini Tekrarlamamız Gerekir mi?

Objective: Patients using anticoagulant and/or antiplatelet (AC/AP) medications are at an increased risk of intracranial hemorrhage (ICH) subsequent to head trauma and current guidelines recommend a head computed tomography (CT) scan for these patients. There is a lack of consensus about management recommendations for mild head trauma patients on AC/AP treatment who had an initially normal head CT. The aim of this study was to determine the rate of delayed ICH after a 24-hour observation in patients with mild head trauma using AC/AP who had an initially normal head CT. Method: Patients aged 18 and older, using AC/AP drugs with mild head trauma were included prospectively. Patients underwent head CT for suspected bleeding. A repeat CT scan was performed after a 24-hours observation period for the patients who had an initially normal head CT for detecting delayed intracranial hemorrhage. Result: A total of 101 patients were included and, 57.4% (n=58) of the patients were female. Delayed ICH was detected in 2.9% (n=3) of the patients after a 24-hour observation. None of the patients with delayed ICH needed surgical treatment or further intervention. Delayed ICH was found in patients who used acetylsalicylic acid (n=1), dabigatran (n=1), and apixaban (n=1). Conclusion: In patients with mild head trauma using AC/AP, delayed intracranial hemorrhage is rare and may be clinically insignificant. A repeat CT scanning after 24-hour observation may not be necessary for patients with mild head trauma using AC/AP therapy who had initially normal head CT.

Findings on Repeat Posttraumatic Brain Computed Tomography Scans in Older Patients With Minimal Head Trauma and the Impact of Existing Antithrombotic Use.

Evaluate the utility of routine rescanning of older, mild head trauma patients with an initial negative brain computed tomography (CT), who is on a preinjury antithrombotic (AT) agent by assessing the rate of delayed intracranial hemorrhage (dICH), need for surgery, and attributable mortality. Participating centers were trained and provided data collection instruments per institutional review board-approved protocols. Data were obtained from manual chart review and electronic medical record download. Adults ≥55 years seen at Level I/II Trauma Centers, between 2017 and 2019 with suspected head trauma, Glasgow Coma Scale 14 to 15, negative initial brain CT, and no other Abbreviated Injury Scale injuries >2 were identified, grouped by preinjury AT therapy (AT- or AT+) and compared on dICH rate, need for operative neurosurgical intervention, and attributable mortality using univariate analysis (α=.05). A total of 2,950 patients from 24 centers were enrolled; 280 (9.5%) had a repeat brain CT. In those rescanned, the dICH rate was 15/126 (11.9%) for AT- and 6/154 (3.9%) in AT+. Assuming nonrescanned patients did not suffer clinically meaningful dICH, the dICH rate would be 15/2001 (0.7%) for AT- and 6/949 (0.6%) for AT+. No surgical operations were done for dICH. All-cause mortality was 9/2950 (0.3%) and attributable mortality was 1/2950 (0.03%). The attributable death was an AT+, dICH patient whose family declined intervention. In older patients with an initial Glasgow Coma Scale of 14 to 15 and a negative initial brain CT scan, the dICH rate is low (<1%) and of minimal clinical consequence, regardless of AT use. In addition, no patient had operative neurosurgical intervention. Therefore, routine rescanning is not supported based on the results of this study.

Profiles of patients with maxillofacial fractures in emergency department of head and neck surgery division of Dr. Soetomo General Hospital Surabaya in 2021 during COVID-19 pandemic

Background: Maxillofacial fracture is the most common injury in head and neck trauma patients. The Coronavirus disease 2019 (COVID-19) pandemic affects many sectors including restrictions on community mobility. This study aims to determine the profile of patients with maxillofacial fractures during the COVID-19 pandemic. Methods: This descriptive observational study will evaluate the profile of maxillofacial fracture patients who came to the Emergency Department of Head and Neck Surgery Division of Dr. Soetomo General Hospital Surabaya in 2021. Results: Subjects were grouped by gender, age, month of visit and trauma mechanism. The ratio of prevalence between males and females was 5.7:1. The highest age distribution was in the range of 21-30 years (29.8%). Based on the month, the highest number of patients was in January (19.1%). Traffic accidents are the most frequent mechanism of injury by 85.1%. Isolated maxillofacial fractures occur mostly in the mandible by 47.6% and in multiple maxillofacial fractures on the maxillary bone by 76.9%. Associated trauma was found in 78.7% of the subjects, with the highest pattern being intracranial trauma as much as 34.1%. Conclusion: There was a decreasing incidence of maxillofacial fracture cases in 2021. The highest prevalence was in males and most of the patients were in 21-30 years age group.

Computed Tomography Scan Findings in Various Modes of Head Injury, Using GE Optima 128 Slice CT Scanner`

Background: Head injury is a global health problem that can cause disability and may result in death. CT scan detects and precisely localizes the skull fractures, epidural/subdural/subarachnoid hemorrhages, brain contusions and cerebral edema etc. CT has proven to be a valuable tool in the early diagnosis and prompt management of head trauma patients and has resulted in significant improvement in morbidity and mortality. Methods: A descriptive cross-sectional study, including 380 patients, presented to Radiology Department of Hayatabad Medical Complex with a history of head trauma for computed tomography examination, from October 2019 to October 2020. The nature of the brain and skull lesions was analyzed in our study and the frequency of various findings was recorded. Results: Among 380 patients, the majority were males (248) making the male to female ratio to be around 2:1. The most prevalent finding was skull fractures (23.4%) followed by cerebral contusions (17.1%). Among extra-axial brain hemorrhages, extradural hematoma (15.2%) was observed more than subdural hematoma (6.8%) while only 3.4% presented with subarachnoid hemorrhages which also included intraventricular hemorrhages. Practical Implication: As road traffic accidents are the most common cause of head injuries so road traffic safety measures ought to be strictly enforced. Most of the CT scan done during head injuries were normal so CT guidelines for ordering should be implemented to scale back extra patient irradiation, unnecessary waste of resources and a further burden on the radiology department. Keywords: Head Injury, Computed Tomography (CT), Road Traffic Accidents (RTA), Skull Fractures, Epidural Hematoma.

Factors associated with the severity of traumatic brain injury.

Traumatic brain injury (TBI) is a defect in the brain function resulting from the action of external factors. The condition ranges from transient shifts in cellular ionic concentrations to total structural damage; the clinical symptoms can vary from brief confusion to death. The current classification system, based on the Glasgow Coma Scale (GCS), divides TBI into mild (GCS 14 to 15), moderate (GCS 9 to 13), and severe TBI (GCS 3 to 8). The leading causes of head injury in the population can be falls, motor vehicle collisions, blasts, and bullet injuries. The ultimate survival and neurologic outcome of the head trauma patient depend on the extent of TBI occurring at the time of injury. The aim of the study is to assess the factors associated with brain injury and their effect on its severity. A cross sectional, retrospective study including 469 adult patients with head injury was carried out in the emergency department of Baghdad teaching hospital between 1 October 2016 - 30 October 2017. Data of all the patients were entered and analyzed using the statistical package for social sciences (SPSS) software for Windows, version 24. The significance of correlation was assessed using a Chi-square test. Level of significance was set at ≤ 0.05. Final findings were presented in tables with an explanatory paragraph for each table using the MS. Office (Word 2013) for Windows. A total number of 469 patients were enrolled in this study with a mean age of 42.6 ± 13.7 years. The vast majority of the patients were males (383/469), which represented 81.7%. The male to female ratio was 4.45 to 1. The distribution of the patients according to their traumatic brain injury was 241 patients (51.4%) with mild, 99 (21.1%) with moderate and 129 (27.5%) with severe TBI. Associated injuries among the studied group were facial injuries in 133 (28.4%), skull fracture in 150 (32%), and thoracolumbar fracture in 51 (10.9%). The associated injuries were more frequent in the extremities - 112/469 (23.9%), combined injuries in 112 (23.9%), chest and abdomen injuries were reported in only 6% and 6.8%, respectively. The causes of injuries in the studied group were road traffic accidents (RTA), the most frequent mechanism - 37.1% of the cases, followed by fall from height (FFH) (23.9%), blast injury (16.8%), bullet injury (13%), while other mechanisms represented only (9.2%). There is a significant association reported with gender, where severe injuries were more frequent among males than females (P=0.014). All associated injuries were significantly associated with severe traumatic brain injury (P<0.05), also bullet injury was significantly associated with severe traumatic brain injury, followed by blast injury (P<0.001). Severe traumatic brain injury was significantly associated with the presence of clinical and radiographic findings (P<0.001). The severity of TBI is significantly related to the type of the associated injury, mechanism of injury, clinical and radiological findings, and to the male gender, while it is not dependent on the age of the patient.

Do concussed and non-concussed head trauma individuals have similar symptoms? A retrospective chart review of chronic post-concussive symptomatology

Many head trauma patients who present with prolonged post-concussion symptoms do not meet the American Congress of Rehabilitation Medicine (ACRM) diagnostic criteria for mild traumatic brain injuries (mTBI). This population has not been extensively studied and its clinical characteristics are currently uncertain. A retrospective chart review was conducted to explore the symptomatic differences between mTBI and non-mTBI head trauma patients presenting at a concussion clinic with chronic post-concussion symptoms (PCSx). Patient information was extracted from 161 charts, of which 128 subjects met the ACRM criteria for mTBI (ACRM + PCSx), while 33 did not (non-ACRM + PCSx). These two groups were compared for demographic variables and symptomology. This study found that 20.5% of subjects presenting with chronic post-concussion symptoms do not meet ACRM criteria. No symptom-specific differences were found between the two populations in any of the categories tested. These results show that chronic post-concussion symptoms are similar in both mTBI and non-mTBI head trauma patients in the general population, suggesting a need for further research focusing on this group.