Higher Incidence Of Head Injuries Research Articles

Incidence of pediatric traumatic brain injury (TBI) during the working hours of parents and caregivers in Saudi Arabia: A survey study.

Traumatic brain injury (TBI) is a common result of external physical forces that damage the brain, affecting over 50 million people annually, with a higher prevalence in males. Children aged 0-4 years are the most susceptible, particularly in low-and middle-income countries, where 90% of TBI-related deaths occur. TBI significantly affects children's quality of life. This study aimed to estimate the incidence of pediatric TBI during working hours among parents and caregivers in Saudi Arabia. A questionnaire-based cross-sectional survey was conducted over 2 months, from July to August 2023. The survey data were electronically gathered using a questionnaire sent over social media channels. It includes working as a caregiver for children in Saudi Arabia. Involving 395 respondents, the primary focus was on child head injuries occurring during the working hours of parents and caregivers. Most respondents were in the 36-45 age bracket, predominantly female (66.1%) and married (81.8%). The age of the child at the time of injury was significantly associated with head injuries during parents' and caregivers' working hours, with the highest incidence among children aged 7-14 years (83.1%). The severity of the injury, hospital admission, need for intensive care, and surgical intervention were significantly associated with child injuries during these hours. In this study, we found a significantly higher incidence of head injuries in children during the working hours of both parents and caregivers. Factors such as longer work hours, the presence of a nanny, more children, male gender, and older child age were associated with this risk.

472 Effects of Recurrent Mild Traumatic Brain Injuries on Incidence, Severity, and Recovery of Concussion in Young Student-Athletes

INTRODUCTION: Currently, it is known that athletes who sustain recurrent concussions are at an increased risk for long-term neurological consequences. Moreover, in the short term, athletes with a history of concussions are significantly more likely to sustain future concussions. Although the increased incidence of mTBI among athletes with a history of concussions has been well documented, there is less consensus about how recurrent concussions affect the severity and recovery of the next head trauma. METHODS: Data from 11 563 ImPACT baseline evaluations of US student-athletes aged 12 to 22 years were separated into 2 cohorts: subjects reporting 2 or more previous concussions (PC; n = 976 baseline evaluations) at baseline and a control group reporting zero previous concussions (CT; n = 7743 baseline evaluations). Subjects reporting 1 prior concussion were excluded. Differences in SND incidence, severity, and recovery between the 2 cohorts were assessed using chi-squared tests, t tests, survival analyses, and multivariate regressions. RESULTS: The PC cohort had a higher incidence of head injury leading to ImPACT (436.7 per 1000 person-years vs 194.4 per 1000 person-years, P < .0001) and a higher incidence of SND (140.4 vs 71.8, P < .0001) than controls. However, the Severity Index (SI) demonstrated that SND severity was lower in the PC group (7.55 vs 8.59, P = .04). Adjusted analyses similarly demonstrated that the PC cohort had increased SND incidence (odds ratio = 1.93; 95% CI, 1.61 to 2.31; P < .0001), decreased SI (β = −1.37; 95% CI, −2.40 to −0.34; P = .009), and equivalent recovery (hazard ratio = 0.98; 95% CI, 0.76 to 1.72; P = .90). CONCLUSION: Participants with a history of concussion have a higher incidence of SND but present with lower severity SND, which may be a result of increased concussion education or symptom awareness. Recurrent concussion has no significant impact on acute neurocognitive recovery. Together, these results provide evidence against the supposition that a history of concussion increases the severity of future SND.

Effects of Recurrent Mild Traumatic Brain Injuries on Incidence, Severity, and Recovery of Concussion in Young Student-Athletes.

To examine the effects of recurrent concussions on the incidence, severity, and recovery of significant neurocognitive dysfunction (SND) in young athletes. Various US youth sports organizations that utilize Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) for baseline and postinjury concussion testing. Data from 11 563 ImPACT baseline evaluations of US student-athletes aged 12 to 22 years were separated into 2 cohorts: subjects reporting 2 or more previous concussions (PC; n = 976 baseline evaluations) at baseline and a control group reporting zero previous concussions (CT; n = 7743 baseline evaluations). Subjects reporting 1 prior concussion were excluded. Retrospective cohort. Differences in SND incidence, severity, and recovery between the 2 cohorts were assessed using chi-squared tests, t tests, survival analyses, and multivariate regressions. The PC cohort had a higher incidence of head injury leading to ImPACT (436.7 per 1000 person-years vs 194.4 per 1000 person-years, P < .0001) and a higher incidence of SND (140.4 vs 71.8, P < .0001) than controls. However, the Severity Index (SI) demonstrated that SND severity was lower in the PC group (7.55 vs 8.59, P = .04). Adjusted analyses similarly demonstrated that the PC cohort had increased SND incidence (odds ratio = 1.93; 95% CI, 1.61 to 2.31; P < .0001), decreased SI (β = -1.37; 95% CI, -2.40 to -0.34; P = .009), and equivalent recovery (hazard ratio = 0.98; 95% CI, 0.76 to 1.72; P = .90). Participants with a history of concussion have a higher incidence of SND but present with lower severity SND, which may be a result of increased concussion education or symptom awareness. Recurrent concussion has no significant impact on acute neurocognitive recovery. Together, these results provide evidence against the supposition that a history of concussion increases the severity of future SND.

Epidemiology of paediatric injuries in Rwanda using a prospective trauma registry.

BackgroundChild survival initiatives historically prioritized efforts to reduce child morbidity and mortality from infectious diseases and maternal conditions. Little attention has been devoted to paediatric injuries in resource‐limited settings. This study aimed to evaluate the demographics and outcomes of paediatric injury in a sub‐Saharan African country in an effort to improve prevention and treatment.MethodsA prospective trauma registry was established at the two university teaching campuses of the University of Rwanda to record systematically patient demographics, prehospital care, initial physiology and patient outcomes from May 2011 to July 2015. Univariable analysis was performed for demographic characteristics, injury mechanisms, geographical location and outcomes. Multivariable analysis was performed for mortality estimates.ResultsOf 11 036 patients in the registry, 3010 (27·3 per cent) were under 18 years of age. Paediatric patients were predominantly boys (69·9 per cent) and the median age was 8 years. The mortality rate was 4·8 per cent. Falls were the most common injury (45·3 per cent), followed by road traffic accidents (30·9 per cent), burns (10·7 per cent) and blunt force/assault (7·5 per cent). Patients treated in the capital city, Kigali, had a higher incidence of head injury (7·6 per cent versus 2·0 per cent in a rural town, P < 0·001; odds ratio (OR) 4·08, 95 per cent c.i. 2·61 to 6·38) and a higher overall injury‐related mortality rate (adjusted OR 3·00, 1·50 to 6·01; P = 0·019). Pedestrians had higher overall injury‐related mortality compared with other road users (adjusted OR 3·26, 1·37 to 7·73; P = 0·007).ConclusionPaediatric injury is a significant contributor to morbidity and mortality. Delineating trauma demographics is important when planning resource utilization and capacity‐building efforts to address paediatric injury in low‐resource settings and identify vulnerable populations.

The impact of helmet use on outcomes after a motorcycle crash

BackgroundHelmet use in a motorcycle collision has been shown to reduce head injury and death. Its protective effect on the cervical spine (C-spine), however, remains unclear. The objective of this study was to explore the relationship between helmet use and C-spine injuries. MethodRetrospective National Trauma Data Bank (NTDB) study. All motorcycle collisions between 2007 and 2014 involving either a driver or passenger were included. Data collected included demographics, vital signs, Abbreviated Injury Scale (AIS), Injury Severity Score (ISS) and specific injuries. The primary outcome was the prevalence of C-spine injuries. Secondary outcomes included were overall mortality, ventilation days, intensive care unit length of stay (LOS), total hospital LOS, and in-hospital complications. ResultsA total of 270,525 patients were included. Helmets were worn by 57.6% of motorcyclists. The non-helmeted group was found to have a higher incidence of head injury with head AIS>2 (27.6% vs 14.8%, p<0.001). Univariate analysis showed a higher prevalence of C-spine injuries in the non-helmeted group (10.4% vs 9.4%, p<0.001), with a higher proportion of severe C-spine injuries with AIS>2 (3.2% vs 2.6%, p<0.001). Additionally, traumatic brain injury (TBI) was found to be two times higher in the non-helmeted group (20.7% vs 10.9%, p<0.001). Multiple logistic regression showed helmet use to be an independent protective factor against mortality (OR=0.832, 95% CI 0.781–0.887, p<0.001). Although statistically significant in univariate analysis, helmet use was not associated with C-spine injuries after adjusting for relevant covariates. However, helmet use reduced the risk of severe head injuries by almost 50% (OR=0.488, 95% CI 0.475–0.500, p<0.001). ConclusionsHelmet use reduces the risk of head injury and death among motorcyclists; however, no association with C-spine injuries could be detected.

Pediatric emergency department thoracotomy: A 40-year review

Background/purposeEmergency department thoracotomy (EDT) has been proposed to be futile in the pediatric patient population. This extreme procedure has survival rates of 0 to 26% in the nonadult population. When taking into consideration that the mechanism of injury is one of the strongest predictors of survival, we hypothesize that the low survival rate in pediatric patients is attributable to a higher rate of blunt trauma compared to their adolescent counterparts. MethodsProspective data collected from our level 1 trauma center from 1974 to 2014 on all patients undergoing EDT at our institution were evaluated for age 18years or younger. Patient predictor variables included injury mechanism, injury pattern, and detected cardiac activity in the field. Outcomes included successful resuscitation (reestablish of blood pressure and taken to operating room) and overall survival. Patients were dichotomized by age into pediatric (age≤15years) and adolescent (16–18years) categories. Results1691 patients who underwent EDT were evaluated for age of 18years or less, which included 179 patents (11%). Overall survival in the adult population was 6.1%, compared to 3.4% in the nonadult population (p=0.157). Pediatric patients were more likely to sustain blunt injury than adolescents (72% vs 32%, p<0.001). This also corresponded to differences in anatomic injury patterns and more multisystem trauma (52% vs 44%, p=0.001). Adolescents had significantly higher survival rates than pediatric patients (5% vs 0%, p=0.036). ConclusionIn nonadult patients undergoing EDT, adolescents have a higher survival rate than pediatric patients. The pediatric population had a significantly lower incidence of penetrating trauma and higher incidence of head injury. The discrepancy in survival between adolescent and pediatric patients appears to be attributable to differences in mechanism. Therefore, those pediatric patients with penetrating thoracic injuries may still benefit from EDT.

Accidentes de bicicleta atendidos en los Servicios de Urgencias. Estudio multicéntrico

ObjectivesTo describe epidemiological characteristics, types of injury, prognosis and medical management of bicycle-related Paediatric Emergency Department (ED) visits and to identify potential preventive measures. Patients and methodsThis multicentred, observational prospective study included all children between 3 and 16 years of age treated for bicycle-related injuries in the Emergency Departments of 15 Spanish Hospitals belonging to the «Unintentional Paediatric Injury Workshop» of the Spanish Paediatric Emergency Society between the 1st of June 2011 and the 31st of May 2012. Characteristics of all ED visits, as well as epidemiological data and accident-related information, were collected. ResultsA total of 846 patients were included in the study, with a male predominance (72.9%) and a median age of 9.6±3.6 years. Head injury was the third most common injury (22.3%) and the main cause of admission to the Pediatric Intensive Care Unit (PICU) (68.4%). More than three-quarters (77.9%) of the patients did not wear a helmet, which was significantly associated to a higher incidence of head injury and admission to PICU. Older children (OR 1.063) and bicycle injuries involving motor vehicles (OR 2.431) were identified as independent risk factors for worse outcomes. ConclusionsSince helmet use reduces up to 88% of central nervous system lesions secondary to head injury, promotion of its use should be the main preventive measure, followed by restriction of bike-riding to cycling areas.

Age differences in brain injury characteristics

Purpose: Traumatic brain injury (TBI) is an important cause of morbidity and mortality in children. Despite the high incidence of head injury among children, the mortality rate is low. There is a lack of studies that describe children's age-specific symptoms in relation to outcome. The purpose is to investigate if other described symptoms could be used as a predictor of intracranial injury in children.Methods: Retrospective review of data from all children who during 1 year were admitted due to a brain injury.Results: During 1 year 724 children visited the ED due to a brain injury. A significant difference was found between age groups and other documented initial symptoms, but no single symptoms could be used as a predictor for intracranial injury.Conclusion: Unconsciousness as a predictor for brain injury should be used with caution in children. Significant differences were found in other documented symptoms between age groups.

Emergency air medical services for patients with head injury

Background Patients suffering head injury in remote islands of Taiwan, which have a shortage of manpower and facilities, depend on EAMS for prompt and definitive treatment. Emergency air medical services are becoming an increasingly important issue in improving the quality of primary care and avoiding medicolegal problems. The purpose of this study was to investigate the characteristics of patients with head injury and use of EAMS. Methods We reviewed all patients, especially head injury transported by air ambulance from a remote island, Kinmen (400 km from Taiwan Main Island), from January 2001 to December 2003. Data were collected with regard to demographics, disease classification, mechanism of injury, severity of head injury, ventilator use, and mortality rate. Results A total of 215 patients were transferred, of whom 57 (27%) had head injury. The mean age of patients was 48.6 ± 23.8 years. Males accounted for 72% of the cases (male/female ratio, 2.6:1). Motor-vehicle accidents were the most common mechanism of injury (68%). There were 21 (37%), 20 (35%), and 16 (28%) patients in the minor, moderate, and severe head-injury groups, respectively. Nineteen patients (33%) received mechanical ventilation. The overall mortality rate was 14 % (8/57). In the severe head-injury group, the mortality rate was 44% (7/16). Conclusions The higher incidence of head injury (26.5%) in EAMS than in ground transportation (19.8%) suggests that preflight assessment and in-flight management of patients conducted by an experienced escort team following guidelines for head injury in EAMS are a very important issue.

Alcohol related falls: an interesting pattern of injuries

Objective: To discover if there is a significant difference in the pattern and severity of injury sustained during falls in patients who have consumed alcohol and those who have not....

Descriptive Epidemiology of Head Injury in Romagna and Trentino

We studied the occurrence of head injury in two different Italian regions: Romagna and Trentino. Both geographical areas attract large numbers of seasonal tourists. The study was carried out over 1 year (January 1, 1998 to December 31, 1998), prospectively in Romagna and retrospectively in Trentino because of their different head injury management protocols. The study was based on all admissions to hospital extracted by medical staff from the case records, and all cases were identified by the ICD-9 codes (ranges: 800.0–800.3, 801.0–801.3, 803.0–803.3, 850, 851.0–851.1, 852.0–852.1, 853.0–853.1, 854.0–854.1). The annual incidence of hospitalization for head injury was 314/100,000, 297 for Romagna and 332 for Trentino. The causes of head trauma and the type of injuries were similar to those reported in the international literature, and so were the characteristics of the population at risk. Romagna recorded a higher incidence of head injury among the elderly, probably due to the widespread use of bicycles without safety helmets. In Romagna, where neurosurgery departments exist, hospital mortality was low (8/100,000/year). Based on similar international literature findings, different prevention measures are suggested to reduce the occurrence and severity of head injury.

PREVENTION OF CHILDHOOD PEDESTRIAN TRAUMA

Merrell, Gregory A. MD; Driscoll, Jon C. MD; Degutis, Linda C. DrPH; Renshaw, Thomas S. MD Author Information

Pediatric trauma anesthesia

Trauma has a significant impact on pediatric morbidity and mortality. Depending on the emergency medical services and health care system, anesthesiologists may be involved in pediatric trauma care at the scene, in the emergency department, in the operating room, or in the intensive care unit. Familiarity with the pathophysiology of pediatric trauma and age-dependent anatomical and physiological features is, therefore, essential to every anesthesiologist. Fast and appropriate interventions with respect to the clinical status and the suspected injuries are the key to successful treatment. Due to the high incidence of head injury, airway management and hemodynamic stabilization are of utmost importance. For preclinical trauma care, however, evidence-based data showing a gold standard for pediatric trauma care are still lacking.

Equestrian injuries: a five year review of hospital admissions in British Columbia, Canada

Aim—To determine the demographics of hospital admissions and mortality associated with equestrian activities in the 33 000 riders in British Columbia (BC). Method—Analysis of admission data from the Ministry of...

Head injuries in Vietnamese refugees in Hong Kong

The Vietnamese refugee camps in Hong Kong represent a unique social situation, where as many as 55 000 people have at one time lived. The Neurosurgical Division of the Prince of Wales Hospital receives all head injured patients from two of the largest camps for management. A retrospective analysis was undertaken of all Vietnamese patients hospitalised with head injuries over a four year period from January 1990 to December 1993. Our results showed that there was a higher incidence of head injuries as compared to epidemiological studies in the USA ( Marshall, 1981) and Britain ( Jennett, 1981), with the highest risk group being children aged 12 years and below. The majority of head injuries were minor, with the most common cause being a fall from bed. With these findings, appropriate preventive measures were advised and steps were taken to reduce the incidence of head injuries amongst the Vietnamese children.

Motorcycle helmet use, incidence of head injury, and cost of hospitalization.

Few public safety measures have aroused the controversy generated by mandatory motorcycle helmet legislation. Arguments against the legislation include restriction of hearing and peripheral vision allegedly caused by helmets, the relative lack of cervical spine protection afforded by helmets, and violation of the fundamental notion of freedom of choice for motorcyclists. Prompted by the reintroduction of mandatory helmet legislation in the California State Assembly, data from motorcycle accident casualties cared for at a designated trauma center were reviewed retrospectively. Trauma clinicians are well aware of the management dilemmas associated with severe head injuries. Despite significant developments in early recognition, rapid transport,’ and aggressive treatment, mortality from head injuries remains high.l Studies have shown that patients with head injuries generally have longer stays in both intensive care units and acute care hospitals2 The long-term care needs, limits of rehabilitation, and varying degrees of permanent disability add to the magnitude of this health care problem. The impact of helmet use on motorcycle casualties has been studied in several states; all studies that compared patients with helmets to those without have reported a higher incidence of head injury among nonhelmeted cyclists. Lloyd and associates3 reported on 160 patients in Texas and noted a head injury rate 2 to 3 times greater among nonhelmeted cyclists than those wearing helmets. Rivara and associates4 reviewed 100 patients injured in motorcycle crashes in Arizona; 57% of these patients sustained head injuries. Further, McSwain and Petrocelli’s review5 of motorcycle casualties in four states noted that head injury was more likely to be the most severe injury of the nonhelmeted cyclists. As expected, the patient groups with longer lengths of stay also have higher charges. When attempting to correlate injury severity with cost, O’Malley and associates2 demonstrated that cost is largely dependent on length of stay and they concurred with other investigators who have shown longer lengths of stay for head-injured-patients. Most authors focused the attention on acute care costs as represented by charges, but there also have been attempts to estimate long-term costs. Rivara and associates4 followed patients for a mean time of 20 months and noted that 23% of direct costs were for rehabilitation or readmission. The Arizona study also considered lost productivity and reported a number of patients on subsistence or disability programs after injury, none of whom had required public assistance before their injuries4 Using census reports for potential earnings in 1980, Lloyd and associates3 estimated the “social costs” to be $180 million. Although widely variable, these figures represent a range of total costs for head-injured patients not addressed by initial hospitalization charges.

The epidemiology of logging injuries in the northwest.

Logging is among the most hazardous forms of employment. However, a comprehensive review of severe logging injuries and their outcome has apparently not been previously undertaken. In the present study we review 51 consecutive injured loggers requiring transfer to a regional Level I trauma center. The average age was 34 years and the mode of injury in 67% was being struck by a falling or rolling log. Orthopedic intervention was required most frequently (49%), with neurologic injury in 43%. Two patients died (4%), both secondary to severe head injury, and both survived less than 24 hours. Importantly, while most severely injured patients survived, they required long hospitalizations and had a 58% permanent disability, with more than half of these being brain or spinal cord related. Although the overall number of workers involved in logging is small, the young average age, the work years lost, and the high risk of permanent disability support continued strong efforts to improve overall safety. Particularly, the high incidence of head injury argues strongly for improved and increased use of safety helmets, which may significantly impact the mortality and morbidity of logging accidents.

Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases.

Forty-five cases of diffuse axonal injury (DAI) brought about by nonmissile head injury in humans are analyzed and compared with 132 cases of fatal head injury without DAI. All cases were subjected to a comprehensive neuropathological study. In the patients with DAI a statistically significant lower incidence of lucid interval, fracture of the skull, cerebral contusions, intracranial hematoma, and evidence of high intracranial pressure were found, with a higher incidence of head injury due to road traffic accident. Brain swelling and hypoxic brain damage were not statistically different in the two groups. The features of DAI in humans are compared with the DAI that has been produced in subhuman primates by pure inertial loading brought about by angular acceleration of the head. The available evidence indicates that DAI in human beings occurs at the time of head injury and is not due to complicating factors such as hypoxia, brain swelling, or raised intracranial pressure.

A Statistical Study on Routine Clinical EEG Findings in 5,000 Cases

Abnormal EEG findings at the time of initial examinations--paroxysmal abnormal findings in particular--were studied. 1. Paroxysmal abnormal findings were found in 266 patients with epilepsy, 67 patients with head injury, 29 patients with headache as chief complaint and 82 patients with other disorders in a total of 444 patients (8.9% of all patients examined). 2. Paroxysmal patterns were found only in 266 patients with epilepsy, corresponding to 40.2% of the 661 patients with this disorders on whom EEG was performed. When paroxysmal patterns are not found at the time of initial tracing suspected of epilepsy in a patient clinically, EEG should be repeatedly traced, both routine EEG and the activation with pentetrazol, bemegride, monosodium trichlorethyl phosphate or other drugs. 3. The incidence of paroxysmal patterns in patients with head injury of Araki II to IV types were significantly higher than those in patients of Araki I type (p<0.005). 4. The subjects of this study included as many as 1,634 patients with head injury, corresponding to 32.7% of all subjects, and it appears that the social situation in which traffic accidents and labor hazards have recently been on the increase, reflects this high incidence of head injury.

Some features of traffic accidents.

Some aspects of urban and rural traffic accidents have been studied at the scene of some accidents in Birmingham and the county of Worcestershire. Accidents to pedestrians are essentially an urban problem, occur mainly at low speed, and most of the serious injury comes from the initial contact with the vehicle, rather than from secondary impacts with the road surface. The characteristics of motor-cycle accidents are more varied; in urban areas there are many side impacts, with consequent injury to the lower limbs, while rural collisions are predominantly front on, with a high incidence of head injury. Accidents to car occupants vary according to the environment.