Head Injury Research Articles

Evidence for cellular and solute passage between the brain and skull bone marrow across meninges: A systematic review.

A potential two-way passage of cells and substances between the brain and skull bone marrow may open for new insights into neurological disease. The arachnoid membrane was traditionally considered to restrict cells and larger molecules in CSF from entering the dura and bone marrow directly. However, new data on exchange between brain and skull bone marrow have recently emerged. Here, we conducted a systematic literature to answer the question: What is the current evidence regarding the movement of cells and molecules between the brain and skull bone marrow, spanning CSF and meninges? We excluded studies related to head or skull trauma, cranial fractures or defects, cancer invasion, CSF leakage, spontaneous intracranial hypotension, spinal dura mater, and studies solely focusing on meningeal lymphatic vessels or the passage of substances from CSF to meningeal lymphatic vessels. The review identified 16 studies that provide evidence of communication between the brain, meninges and skull bone marrow. Cells (such as B and T cells and neutrophils), bacteria, and substances (tracers, drug compounds) have been reported to pass between the brain and skull bone. However, most studies are performed in rodents, emphasizing the need for translation to humans.

Inter-facility transfers to an urban level 1 trauma center and rates of secondary overtriage.

Many patients originally transported to non-trauma centers (NTC) require transfer to a trauma center (TC) for treatment. The aim was to analyze injury characteristics and outcomes of transfer patients and investigate the secondary overtriage (SOT). Study included 2,056 transfers to an urban level 1 TC between 01/2016 and 06/2020. Analyzed variables included: demographics, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), transfer reason and timing, computed tomography (CT) scans, surgery rate, intensive care unit (ICU) admissions, hospital lengths of stay (HLOS), mortality and SOT. SOT was defined as discharge within 48h without surgery or ICU admission. Transfers constituted 32.1% of TC admissions. Mean age was 66.7 and 60.7% were geriatric (≥ 65 years). Mean ISS was 11.6 and GCS was 14.3. The average time between NTC and TC admission was 4.2h. Main reason for transfer was a head injury (57.9%), followed by a spine injury (19.2%). CT scans were repeated at the TC in 76.1% of patients. Surgical interventions were necessary in 18.5% of patients, with lowest rate in head (13.8%) and spine (15.4%) injuries. 45.9% of patients required ICU admissions. Overall mortality was 7.2%. SOT was 30.5%, being the highest in patients with spine (43.0%) and head (29.4%) injuries. Short HLOS affected SOT rates the most. Transfers constituted a third of all TC admissions. The main reasons for transfer were head and spine injuries. SOT accounted for one third of transfers and occurred primarily in patients with spine and head injuries.

Pre-injury narcotic drug use in isolated severe traumatic brain injury: effect on outcomes.

The aim of this study was to explore the association between pre-injury narcotic drug use (opioids, methadone, and/or oxycodone) and outcomes in isolated severe traumatic brain injury (TBI) patients. ACS TQIP study included adult trauma patients (≥ 16 years) with complete drug and alcohol screening. Isolated severe TBI was defined as head trauma with AIS 3-5 and without significant extracranial trauma. Exact matching was used to compare patients with isolated pre-injury narcotic drug use to those with no illicit drug or alcohol use. Patients were matched 1:1 based on the following matching criteria: age, gender, mechanism of injury, Injury Severity Score, systolic blood pressure, head AIS, and comorbidities. Of 1,846,630 patients, 141,058 had isolated severe head injuries with complete drug and alcohol screenings. After exact matching, 1,560 patients in each group were analyzed. There were no significant differences in hospital mortality, craniectomy rates, complication rates, or length of hospital stay. Patients that tested positive for narcotics had lower rates of mechanical ventilation (16.5% vs. 25.3%, p < 0.01) and shorter ICU stays [3 (2-4) days vs. 3 (2-6) days; p < 0.01]. Pre-injury narcotic drug use in isolated severe TBI is not associates with adverse outcomes. Further research is needed to understand the biochemical and physiological effects of narcotic drugs on TBI outcomes.

Fulminant Form of Guillain-Barré Syndrome Complicated by Hematoma of the Corpus Callosum Occurring in the Context of Head Trauma: A Case Report

Fulminant Form of Guillain-Barré Syndrome Complicated by Hematoma of the Corpus Callosum Occurring in the Context of Head Trauma: A Case Report

D-dimer cutoff values for predicting functional prognosis in patients with severe head trauma: a multi-centre prospective observational study.

D-dimer, a fibrinolysis indicator, may predict functional and life outcomes in traumatic brain injury (TBI) patients. We aimed to identify optimal D-dimer cutoff values for poor functional outcomes in severe TBI. We used data from a multi-centre prospective observational cohort study that included patients with TBI with a Glasgow Coma Scale (GCS) score ≤ 8 within 48h after injury or required neurosurgical procedures. We selected patients admitted ≤ 1h after injury. Neurological function at discharge was assessed using the modified Rankin Scale (mRS). The association between D-dimer levels at admission and neurological function (mRS ≥ 4 or < 4), adjusted for age, GCS, systolic blood pressure, and head abbreviated injury scale (AIS) score, was determined by logistic regression analysis. The predictive utility of D-dimer levels was assessed using the area under the receiver operating characteristic curve (AUC), with the cutoff value being determined using Youden's index. Among the 336 patients, most were male; approximately half had experienced motor vehicle accidents. The median (interquartile range) of age, GCS scores, and head AIS scores were 65 (40.25 - 78.75) years, 7 (4 - 9), and 5 (4 - 5), respectively. Overall, 214 (63.7%) patients had poor neurological function (mRS ≥ 4). D-dimer levels > 28µg/mL predicted poor functional prognosis (odds ratio = 3.84 [95% confidence interval 1.62 - 9.11]); the AUC and cutoff values were 0.73 and 27.2µg/mL, respectively. A cutoff value of 27.2µg/mL for early-stage D-dimer levels could predict the functional prognosis of patients with severe isolated TBI.

Demographic patterns in horseback riding head and neck injuries within the United States: A NEISS database study.

Our primary objective was to identify and describe demographic trends in head and neck injuries incurred while participating in horseback riding. Cross-sectional analysis. National Database. Head and neck injuries related to horseback riding over a ten-year period (2014-2023) were analyzed using data from the National Electronic Injury Surveillance System (NEISS). A total of 3,177 cases were identified. Inclusion criteria encompassed injuries to the head, neck, face, mouth, or ear. Variables included age, gender, injury type, anatomical location, and patient disposition. Chi-squared analyses were employed to compare the aforementioned injury variables. Among the 3,177 reported injuries of males and females, females (mean age 27.51 years, SD = 19.04) were more likely to be treated and released (83.29 %, n= 2023), while males (mean age 34.65 years, SD = 22.58) were more likely to be hospitalized. There was a significant association between gender and concussion diagnosis (p<.001), with females more likely to be diagnosed with concussions (n = 687) compared to males (n = 129). Females experienced more head and face injuries compared to males. Age distribution varied significantly across disposition categories, indicating different management practices for various age groups. The dataset indicates that the average age of females (27.51 years) is notably lower than that of males (34.65 years), suggesting a younger demographic among females overall. The study highlights a significant gender disparity in horseback riding-related head and neck injuries, with females more likely to be treated and released and males more often requiring hospitalization.

Challenges and effectiveness of remote neurological follow-up of children with concussion following TBI using telemedicine.

Traumatic brain injury (TBI) in children, including concussion, is one of the major causes of emergency department (ED) registration and a significant burden on the health system. The primary goal of this study was to evaluate the outcomes of a telemedicine strategy for remotely monitoring thechildren with traumatic brain concussions, focusing on their neurological symptoms and signs. The secondary goal was to explore socioeconomic and educational differences among the participating families. This study was conducted in a prospective and observational fashion. It included children aged between 6 and 18years who presented in the ED with head trauma and were subsequently diagnosed with a brain concussion. Enrolled patients split into telemedicine-only and telemedicine + readmission groups according to their concussion symptoms during video-call visits. We recruited 29 children and performed 75 telehealth visits. Four children were called for readmission, and they comprised the telemedicine + readmission group. The telemedicine-only group included 25 children whose follow-ups were completed remotely. The median PECARN score was 1 (IQR = 0.75), and the most common reason for head trauma was simple falls from the same level (n = 18, 62%); 22 (76%) children were suffering from headaches; 55% of the families were in very low-income status. During the video-call visit sessions, three children stated worse headaches, and one child's parents reported consistent sleepiness. This study demonstrates the potential effectiveness of telemedicine in monitoring children with concussions, especially in regions with diverse socioeconomic backgrounds and overcrowded metropolitan hospitals.

Types of Road Traffic Accidents and Emergency Medical Care

Introduction: A traffic accident is when only material damage is caused to the vehicle and track environment, and there are no casualties. RTA represents a significant risk for morbidity and mortality in Kosovo, of which head injury and multiple-site injury increase injury severity. The anatomical site, mechanism of injury, time to reach an initial health facility, time of the day, patient condition at ED, type of treatment given, GCS at admission, and days spent in the hospital were among independent predictors of management outcome. Targeted approaches to improving the care of the injured victims may improve outcomes. Thus, the clinician should consider the clinical presentation of RTA and give due attention to the identified contributing factors in managing it. Law enforcers should also emphasize the identified types and mechanisms of accidents. The PubMed database was utilized for article selection, and papers were obtained and reviewed. The ATLS protocol has been developed to manage trauma patients systematically so as not to miss any condition that may kill the patient. Conclusions: Triage is essential in managing accidental situations and strengthening the primary, secondary, and tertiary health systems. To design clinical guidelines, algorithms, and triage protocols at the three levels of health care, all healthcare professionals should be educated and trained with continuing courses in triage, communication, and Basic Life Support -AED, ACLS, PHTLS, BTLS, and ATLS.

Spinal cord injury in abusive and accidental head injury in children, a neuropathological investigation.

The diagnosis of abusive head trauma (AbHT) in children is a challenging one that needs to be differentiated from natural disease and accidental head injury (AcHT). There is increasing evidence from the Neuroradiology field showing spinal cord injury in children subject to AbHT, which has, so far, been poorly investigated pathologically. In this study we retrospectively reviewed the forensic records of 110 paediatric head injury cases over an eight-year-period. The records included detailed circumstances of death and clinical history alongside neuropathology, ophthalmic pathology and osteo-articular pathology. Based on the final multidisciplinary agreement, the 110 case were grouped into AbHT (n = 40), AcHT (n = 9), not clearly accidental or abusive ("undetermined" (UHT) n = 8) and non-traumatic brain injury (NTBI, n = 53). The spinal cord pathology present within each group was compared. Spinal subdural haematoma (SDH) was present in 71% of AbHT and 50% of AcHT cases and were located predominantly at the thoracolumbar level. In AbHT cases without spinal SDH, the suspected mechanism of injury was that of head impact rather than shaking, whilst cases of AcHT with spinal SDH were associated with direct trauma to the spinal cord. Injury of spinal nerve roots in AbHT was almost three times that seen in the accidental head injury group (58% vs. 17%). The study shows that pathological examination of the spinal cord and spinal nerve roots is of high value in investigating AHT and may help in differentiating AbHT from AcHT.

Impact of Earthquakes During COVID-19 Lockdown on the Pediatric Injury Pattern in the Zagreb Urban Area.

Background/Objectives: Previous works on the epidemiology of pediatric trauma during the COVID-19 lockdown observed a decrease in pediatric surgical emergency consultations and fracture referrals. None of those works describes a unique situation in which there is the coexistence of another opposing factor, like an earthquake, that influences the number of injured children's referrals. Therefore, this study aimed to investigate the influence of earthquakes during the COVID-19 lockdown on pediatric injury pattern referrals at a tertiary care hospital in a urban setting. Methods: A retrospective single-center case-control study comprised a time interval at the time of the COVID-19 lockdown, starting with a day when the biggest earthquake happened and finishing at the end of the confinement period in Zagreb, Croatia (22 March-27 April 2020). The control group comprised the identical time interval in 2019. We identified all successive pediatric trauma patients referred to the Pediatric Emergency Department. Demographics and leading injury characteristics were analyzed. Results: We analyzed data from 1166 patients. In the case group, the median age was lower than in the control group but without gender differences. We detected a decrease in Pediatric Emergency Department referrals and a reduced proportion of pediatric trauma patients in the case group. Additionally, the proportion of shoulder/elbow injuries and head injuries was higher, and the proportion of foot/ankle injuries was lower in the case period than in the control period. Conclusions: Earthquakes during the COVID-19 lockdown changed the pattern of pediatric injuries. These data can be used to restructure health resources during similar conditions to provide optimal health care to children.

Basic Medical Emergency Treatment for Maxillofacial Injuries

Introduction: Maxillofacial trauma presents unique challenges due to the complex anatomy of the face, encompassing vital structures. Beyond physical injuries, these cases significantly impact a patient's appearance and function, necessitating a multidisciplinary approach. Challenges: Maxillofacial trauma often co-occurs with other injuries, particularly head, chest, and extremity trauma. This increases complexity, with head injuries observed in 7.6-8.9% of facial fracture cases, frequently associated with lower Glasgow Coma Scores. Cervical spine injuries and airway obstruction are significant concerns. Management: While trauma management has significantly improved mortality rates, maxillofacial injuries in polytrauma patients remain a challenge. Their proximity to the brain, spine, and airway necessitates modifications to standard ABC assessments. These modifications often incorporate DRSABCDE, a comprehensive evaluation that includes airway clearance with C-spine control, breathing, ventilation, oxygenation, circulation, disability-neurologic status, exposure-environment, and body temperature. Each component of DRSABCDE is crucial in the initial management of maxillofacial trauma. Conclusion: Continuous education and training in triage, communication, and advanced life support (e.g., BLS-AED, ACLS, PHTLS, BTLS, ATLS) are crucial and empowering for healthcare professionals managing maxillofacial trauma in polytrauma patients. This ongoing learning equips them with the necessary skills and knowledge to handle these complex cases effectively.

High tackle headache: implications of referee agreement for tackle height law change

ObjectivesRugby Union has a relatively high risk of injury. Early evidence suggests a benefit of lowering tackle height to reduce head and neck injuries, although concerns persist among stakeholders regarding...

Displaced cortical vein sign on CT in infants: a reliable predictor to distinguish low-attenuation subdural collections from benign enlargement of subarachnoid spaces.

Differentiating benign enlargement of subarachnoid spaces (BESS) from low-attenuation subdural collections on CT imaging of infants can be challenging. This distinction is crucial in infants, as subdural collections may raise the concern for abusive head trauma (AHT). To evaluate the utilization of the displaced cortical vein sign on CT as a predictor of pathological subdural collections confirmed by MRI and to assess the reproducibility of this finding among radiologists with different levels of clinical experience. A total of 104 imaging exams were independently reviewed by junior- and senior-level radiologists (52 head CTs and 52 corresponding brain MRI exams). These exams included 43 MRI-confirmed cases of subdural collections and 9 MRI-confirmed cases of BESS from patients aged 0-2 years. The presence of pathological collections and sulcal flattening, and the displaced cortical vein sign were recorded for both reviewers along with attenuation and signal characteristics of the collections. Confirmed diagnosis of AHT was determined by chart review. The sensitivity, specificity, and inter-observer reliability were analyzed between reviewers. The average patient age was 6.4 months with a median age of 4 months. The sensitivity values of the displaced cortical vein sign on CT for the presence of subdural collections were 69.6% and 79.0% for the two reviewers, respectively. The specificity of this finding was 100% for both reviewers, with no false negative cases. Interobserver reliability was the highest for the depiction of the displaced cortical vein sign on CT (κ=0.63, 95% CI 0.45-0.82) and MRI (κ=0.96, 95% CI 0.87-1.00). All cases where at least 1 reviewer noted the displaced cortical vein sign on CT and were later confirmed to be traumatic subdural collection on MRI were concluded to have high concern for AHT upon chart review. In total, 23.3% (11 out of 52) of cases confirmed to have subdural collections on MRI were found to have calvarial fractures associated with their presentation. The displaced cortical vein sign on head CT is a specific and reproducible finding associated with subdural collections. Our data suggest that this sign is a more reliable and readily identifiable indicator of pathological subdural collections compared to other traditional imaging findings, such as flattening of the cerebral sulci.

The diagnostic accuracy of EyeGuide Focus testing for concussion in elite male Rugby players

ABSTRACT Introduction Smooth pursuit eye movements may be affected by head impacts. The EyeGuide Focus system is a simple, portable, test of visual tracking. This study investigated the diagnostic accuracy of EyeGuide measurements for detection of concussion during elite Rugby matches. Methods A prospective diagnostic case–control study was performed in the elite 2021/2022 United Rugby Championship competition. The study population comprised consecutive players identified with match-related head impact events during the World Rugby Head Injury Assessment process, randomly chosen uninjured players, and players with match-related musculoskeletal injuries. The index test was blinded EyeGuide assessment performed by independent assessors. The reference standard was concussion diagnosed by the team doctor. Distributions of EyeGuide scores were compared between concussed and non-concussed players and receiver operator characteristic curves constructed. Results EyeGuide testing was performed in 262 cases, comprising 55 concussed players and 207 non concussed players (33 head impact events, 97 uninjured controls, and 79 musculoskeletal injury controls). The distributions of EyeGuide score were similar between concussed and non-concussed cases (medians 20,120 Vs 21,522, p = 0.3; difference −1,402, 95% CI −5,332–3,865). The c-index for the receiver operating characteristic curve was 0.46 (95% CI 0.36–0.55). Conclusions EyeGuide Focus scores did not appear to discriminate between concussed and non-concussed players in a cohort of elite Rugby players.

Predicting fall parameters from infant skull fractures using machine learning.

When infants are admitted to the hospital with skull fractures, providers must distinguish between cases of accidental and abusive head trauma. Limited information about the incident is available in such cases, and witness statements are not always reliable. In this study, we introduce a novel, data-driven approach to predict fall parameters that lead to skull fractures in infants in order to aid in determinations of abusive head trauma. We utilize a state-of-the-art finite element fracture simulation framework to generate a unique dataset of skull fracture patterns from simulated falls. We then extract features from the resulting fracture patterns in this dataset to be used as input into machine learning models. We compare seven machine learning models on their abilities to predict two fall parameters: impact site and fall height. The results from our best-performing models demonstrate that while predicting the exact fall height remains challenging ( 0.27 for the ridge regression model), we can effectively identify potential impact sites ( between 0.65 and 0.76 for the random forest regression model). This work not only provides a tool to enhance the ability to assess abuse in cases of pediatric head trauma, but also advocates for advancements in computational models to simulate complex skull fractures.

Head and neck injuries from personal motorised vehicles in the United States

BackgroundThe use of personal electric vehicles in the United States has increased head and neck injuries. This study analyses the types, frequencies, demographics and management of these injuries across motorised...

Not all quad bikers are the same: unsupervised cluster analysis identifying injury risk groups among quad bike riders in Dubai, UAE

ObjectiveQuad bike riders in Dubai (UAE) constitute a highly diverse group with varying driving skills and familiarity with the desert environment. In the absence of evidence on the quad bike...

Examination of patients presenting to the emergency department as "apparently drunk".

Alcohol, a significant public health concern, contributes to a substantial burden on emergency services. Identifying avoidable causes of Emergency Department (ED) presentations may reduce hospital overcrowding and benefit public health. This prevalence study aims to provide a detailed analysis of patients presenting to the ED at Mercy University Hospital (MUH) as "Apparently Drunk" in 2022 and 2023. Data were sourced from the Integrated Patient Management Information System at MUH. All patients recorded as "Apparently Drunk" were included. Data collected included demographics, associated injuries or complaints, mode of arrival, admission status, and discharge status. Descriptive statistics were used to summarise the data and trends were examined by comparing 2022 and 2023 data. A total of 1662 presentations were categorised as "Apparently Drunk," representing 3% of all ED visits. There was an 18% increase in such presentations from 2022 to 2023. The majority of patients were male (72%). The median age was 39years. Notably, 23% of the presentations involved people experiencing homelessness, and 81% were conveyed by ambulance. Significant associated injuries included head injuries (7%), falls/collapses (6%), mental health issues (5%), and assaults (4%). The findings indicate a growing trend in patients presenting to the ED as "Apparently Drunk". The high incidence among people experiencing homelessness and the substantial resource utilisation underscores the need for targeted public health interventions and integrated services. Policymakers should consider these findings in the context of potential legislative changes that may impact alcohol availability.

Clinical characteristics and long-term follow-up study of basal ganglia infarction after minor head trauma in infants and young children

To investigate the clinical characteristics and prognosis of infants and young children with basal ganglia infarction after minor head trauma (BGIMHT). A retrospective analysis was conducted on the clinical data and follow-up results of children aged 28 days to 3 years with BGIMHT who were hospitalized at Children's Hospital of Soochow University from January 2011 to January 2022. A total of 45 cases of BGIMHT were included, with the most common symptom being limb movement disorders (96%, 43/45), followed by facioplegia (56%, 25/45). Cerebral imaging showed that 72% (31/43) had infarction accompanied by basal ganglia calcification. After conservative treatment, 42 children (93%) showed significant symptom improvement, while 3 children (7%) experienced recurrent strokes. The median follow-up time was 82 months (range: 17-141 months). At the last follow-up, 97% (29/30) had residual basal ganglia softening lesions. Among 29 cases participating in questionnaire follow-up, 66% (19/29) recovered normally, 17% (5/29) showed significant improvement in symptoms, and 17% (5/29) had poor improvement. According to the grading of the Global Burden of Disease Control Projects, only 1 child (3%) had severe sequelae. There were no significant differences in age at onset, gender, or presence of concomitant basal ganglia calcification between children with and without neurological sequelae (P>0.05). The most common initial symptom of BGIMHT is limb movement disorder, and imaging results indicate that most children have concurrent intracranial calcifications. Most infarct lesions later transform into softening lesions, resulting in a generally good prognosis.

Determinants of epilepsy among outpatients in public health institutions of Dawo district, South West Shoa Zone, Oromia, Ethiopia, 2023: an institutional-based unmatched case-control study

BackgroundGlobally, in ~50% of epilepsy cases, the underlying cause remains unknown, despite the fact that various disease pathways may contribute to the condition. Nearly 80% of people with epilepsy live in low- and middle-income countries and the risk of premature death in people with epilepsy is up to three times higher than that for the general population. Identifying the determinants of epilepsy is important for applying evidence-based interventions to achieve a better outcome. However, this information is scarce in a country with limited resources like Ethiopia.ObjectiveThis study aimed to assess the determinant of epilepsy among outpatients in Dawo public health institutions, from 29 February to 15 April 2023.MethodAn institution-based unmatched case-control study design was used, involving 61 cases and 122 control study subjects, who were selected using a consecutive sampling technique from public health institutions in Dawo. Data were collected using a pre-tested structured questionnaire. The data were coded, entered into EpiDATA version 3.1, and exported to SPSS version 20, for further analysis. Descriptive analysis was used to determine the percentages and frequency distributions. Logistic regression analysis was used to identify the determinants of epilepsy, and a variable with p &amp;lt; 0.05 was considered statistically significant.ResultsA total of 61 cases and 120 controls were included in the study, with an overall response rate of 98.90%. The majority of participants, 38 (62.3) of the cases and 63 (52.5) of the controls, were farmers by occupation. A family history of epilepsy (AOR = 13.71 95% CI 3.030–22.006), history of febrile seizure (AOR = 14.57 95% CI 2.930–24.522), history of head injury (AOR = 6.853 95% CI 1.780–16.402), and non-use of latrine were found to be determinants of epilepsy (AOR = 0.028 95% CI 0.008–0.040).Conclusion and recommendationsThe current study identified a family history of epilepsy, a history of febrile seizures, head injury, and unavailability of latrines as independent predictors of epilepsy in the study area. The information that adverse febrile seizures increase the risk of epilepsy suggests that a significant proportion of epilepsy cases in Dawo district could be prevented through improved maternal, neonatal, and child care. It is recommended that the Dawo Health Office, along with relevant stakeholders, focus on addressing this issue at various levels.