Incidence Of Head Injuries Research Articles

Combat-Related Craniofacial and Cervical Injuries: A 5-Year Review From the British Military

Recent international publications have noted a sustained increase in the incidence of head, face, and neck (HFN) wounds in comparison with total battle injuries from the 20th to the 21st century. The aim of this review was therefore to perform an analysis of the epidemiology of all HFN injuries sustained by British forces in Iraq and Afghanistan from March 1, 2003, to December 31, 2008. Descriptive injury data for this research were obtained from the Joint Theater Trauma Registry and overall battle injury and evacuation figures from the Defense Analytical and Statistical Agency. During this period, 448 servicemen sustained injuries to their HFN. A total of 71% of HFN injuries were sustained in battle. Of all service personnel sustaining HFN injuries, 32% died before the field hospital and a further 6% died subsequently. A total of 73% of injuries required evacuation back to the United Kingdom, whereas 27% of injuries were managed definitively in the theater of operations. HFN injuries altogether were found in 29% of battle injuries between 2006 and 2008. The individual incidences of head (15%) and face (19%) injuries in relation to total battle injuries, although greater than seen in previous United Kingdom conflicts, were only slightly higher than that seen by US forces. The incidence of neck injury alone in relation to total battle injuries of 11% in United Kingdom forces in comparison with 3% to 5% found in US forces warrants further investigation. This article also provides further evidence to support the existing published opinion of multiple international authors in the requirement to develop innovative methods of protecting the vulnerable HFN regions.

In-Hospital Treated Pediatric Injuries are Increasing in Finland — A Population Based Study between 1997 AND 2006

Injuries are an important public health problem as well as the leading cause of death and disability among children. Our aim was to longitudinally explore the incidence of in-hospital treated traumas, their operative treatment and related mortality among pediatric patients in Finland. The National Hospital Discharge Register and the Official Cause-of-Death Statistics data of in-hospital treated pediatric trauma patients between 1997 and 2006 in Finland were evaluated for hospitalizations, treatment modality and mortality. Fractures (69%) and head injuries (28%) were the most common in-hospital treated traumas (477/100,000 persons/year). These were followed by injuries of intra-abdominal (1.4%), thoracic (1.2%) and urological organs (0.6%). Head traumas constituted 67% of injury-related deaths. During the ten-year follow-up period, the annual incidence (per 100,000 persons) of head injuries decreased by 13.6% (152 in 1997 vs. 131 in 2006, p < 0.0001) mainly contributing to a 30% decrease in overall injury-related mortality incidence (from 5.7 in 1997 to 4.0 in 2006, p = 0.0519). The overall trauma incidence, and incidence of fractures and abdominal injuries significantly increased by 5.0% (p < 0.0001), 13.5% (p < 0.0001) and 37% (p < 0.05), respectively, while the incidence of thoracic and urological injuries remained unchanged. Up to 15% of spleen injuries lead to splenectomy. Although overall and head trauma-related mortality is decreasing, the increasing incidence of fractures and abdominal injuries has amplified the overall incidence of severe injuries among children in Finland. A significant number of unnecessary splenectomies are still performed among children.

Aetiological spectrum, injury characteristics and treatment outcome of head injury patients at Bugando Medical Centre in north-western Tanzania

Head injury is considered as a major health problem that is a frequent cause of death and disability and makes considerable demands on health services. A cross-sectional study was conducted to determine the etiological spectrum, injury characteristics and treatment outcome of head injury patients at Bugando Medical Centre (BMC) in North-western Tanzania. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS programme. A total of 260 head injury patients (mean age=26.84 years) were studied. Males outnumbered females by a ratio of 1.5:1. Road traffic accidents (RTAs) were the most common cause of injury accounting for 49.2% of patients. Scalp injuries, cerebral concussion and skull fractures were the most common type of head injuries. Fifty-six (21.5%) patients had associated injuries of which musculoskeletal region (36.1%) was commonly affected. Most of patients (66.1%) sustained mild head injury. The majority of patients (75.8%) were treated conservatively and only 24.2% of patients needed surgical interventions. Most of patients (85.4%) had good recovery. The mean hospital stay (LOS) was 24.56 days and the mortality rate was 11.2%. Patients who had RTAs, penetrating head injuries, associated long bone fractures and those who were treated surgically were found to have significantly longer LOS (P< 0.001). Mortality was found to be significantly associated with extreme of age, presence of pre-morbid illness and associated injuries, admission Glasgow Coma Score < 9, systolic blood pressure < 90mmHg, injury severity core > or =16, longer duration of loss of consciousness, the need for intensive care unit admission and finding of space occupying lesion on computed tomography scan (P < 0.001). Head injuries resulting from RTAs remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of head injuries in this region.

Mild Traumatic Brain Injury in Children: Ringing the Alert Bell

Despite the high incidence of mild head injuries in children, only recently has there been increasing interest which began when findings from research done in adult patients showed that the effects of mild closed head injuries could interfere significantly with employment and other areas of life. Mild traumatic brain injury (TBI) is a common occurrence around the world and in the United States, its estimated incidence exceeding 1 million injuries per year, with cognitive, emotional, behavioral, and physical impairments as common sequelae. The etiology of these symptoms in individuals with mild TBI is controversial, with hypotheses of postconcussive symptom formation variously ascribing greater or lesser weight to neural damage, psychiatric factors, somatization, malingering, or some combination of these. TBI in children is an enormous problem., as many children will encounter a brain injury. Adolescents and families need to self-monitor symptoms and limit environments or circumstances that exacerbate any symptoms. When symptoms resolve, a gradual progressive return to play is currently recommended. The recurrence risk for subsequent concussions is elevated, but there is limited documentation of the effectiveness of preventative efforts. This review will limit itself to what may refer to as minor traumatic brain injury, primarily in children, with a focus on the assessment and management of this complexity. doi:10.4021/jnr16w

Evaluation of a national campaign in snow sports

BackgroundAround 15% of the 100 000 injuries that occur on ski slopes in Switzerland affect the head. Protective helmets can reduce the incidence of head injuries. Bfu and national partners...

Preventing injuries in water polo: have we scored?

BackgroundInjury surveillance over time is the basis for the identification of injury trends and the development of injury prevention programs.ObjectiveTo analyse the injury trends in water polo over a 5...

Helmet use and reduction in skull fractures in skiers and snowboarders admitted to the hospital

Helmet use has been associated with fewer hospital visits among injured skiers and snowboarders, but there remains no evidence that helmets alter the intracranial injury patterns. The authors hypothesized that helmet use among skiers and snowboarders reduces the incidence of head injury as defined by findings on head CT scans. The authors performed a retrospective review of head-injured skiers and snowboarders at 2 Level I trauma centers in New England over a 6-year period. The primary outcome of interest was intracranial injury evident on CT scans. Secondary outcomes included the following: need for a neurosurgical procedure, presence of spine injury, need for ICU admission, length of stay, discharge location, and death. Of the 57 children identified who sustained a head injury while skiing or snowboarding, 33.3% were wearing a helmet at the time of injury. Of the helmeted patients, 5.3% sustained a calvarial fracture compared with 36.8% of the unhelmeted patients (p = 0.009). Although there was a favorable trend, there was no significant difference in the incidence of epidural hematoma, subdural hematoma, intraparenchymal hemorrhage, subarachnoid hemorrhage, or contusion in helmeted and unhelmeted patients. With regard to secondary outcomes, there were no significant differences between the 2 groups in percentage of patients requiring neurosurgical intervention, percentage requiring admission to an ICU, total length of stay, or percentage discharged home. There was no difference in the incidence of cervical spine injury. There was 1 death in an unhelmeted patient, and there were no deaths among helmeted patients. Among hospitalized children who sustained a head injury while skiing or snowboarding, a significantly lower number of patients suffered a skull fracture if they were wearing helmets at the time of the injury.

The “swing-ding”: a golf-related head injury in children

In recent years there has been an increased incidence of golf-associated head injuries in children and adolescents. At the authors' institution, they have identified a unique pattern of head injury associated with a swinging golf club. In this study, the authors highlight the mechanism of this injury and report their experience treating it. The authors reviewed the database of Rainbow Babies and Children's Hospital Trauma Center and performed a retrospective analysis of golf injuries recorded over a 10-year period (January 2000-April 2010). They identified 13 children (9 boys and 4 girls) who sustained head injuries in golfing accidents. All patients were 10 years of age or younger. The medical charts were reviewed and follow-up interviews were conducted to better delineate the details of the injuries. Injuries included 13 depressed skull fractures, 7 epidural hematomas, and 1 cerebral contusion. All 13 patients sustained their injuries after being struck in the head by a golf club. Seven sustained injuries on the follow-through of the initial swing and 3 sustained injuries on the backswing. All but one patient required neurosurgical intervention. Five patients developed neurological sequelae. None of the children had prior experience with golf equipment. All but one injury occurred in the child's own backyard. There was no direct supervision by an adult in any of the cases. Golfing can lead to serious head injuries in children. The authors noticed a unique pattern of golf-related head injuries, previously not described, that they have termed the "swing-ding." This golf club-inflicted injury occurs when a child stands too close to a swinging golfer and is struck in the head, subsequently sustaining a comminuted depressed skull fracture in the frontal or temporal region, with or without further intracranial injury. The study suggests that a lack of adult supervision, minimal previous golf experience, and proximity of the child to the swinging golfer are all implicated in this head injury pattern.

Mild Traumatic Brain Injury in Children: Ringing the Alert Bell

Despite the high incidence of mild head injuries in children, only recently has there been increasing interest which began when findings from research done in adult patients showed that the effects of mild closed head injuries could interfere significantly with employment and other areas of life. Mild traumatic brain injury (TBI) is a common occurrence around the world and in the United States, its estimated incidence exceeding 1 million injuries per year, with cognitive, emotional, behavioral, and physical impairments as common sequelae. The etiology of these symptoms in individuals with mild TBI is controversial, with hypotheses of postconcussive symptom formation variously ascribing greater or lesser weight to neural damage, psychiatric factors, somatization, malingering, or some combination of these. TBI in children is an enormous problem., as many children will encounter a brain injury. Adolescents and families need to self-monitor symptoms and limit environments or circumstances that exacerbate any symptoms. When symptoms resolve, a gradual progressive return to play is currently recommended. The recurrence risk for subsequent concussions is elevated, but there is limited documentation of the effectiveness of preventative efforts. This review will limit itself to what may refer to as minor traumatic brain injury, primarily in children, with a focus on the assessment and management of this complexity. J Neurol Res. 2011;1(1):1-5 doi: https://doi.org/10.4021/jnr16w

A Critical Review of Neuroimaging Applications in Sports Concussion

While abnormalities related to concussion are typically not identified on traditional clinical neuroimaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]), more sophisticated neuroimaging techniques have the potential to reveal the complex neurometabolic processes related to concussion and its recovery. Clinically, these techniques may one day provide useful information to guide clinicians in the management and treatment of sports concussion. This article critically reviews the current state of the literature regarding neuroimaging and sports concussion, identifies challenges in the application of these techniques, and identifies areas for future research.

Pre-hospital determinants of outcome in traumatic brain injury: Experiences from first comprehensive integrated pre-hospital care providers in India: GVK — EMRI Experience

Indian studies have reported that nearly 1.5 to 2 million persons are injured and 1 million succumb to death every year in India due to traumatic brain injury. Road traffic injuries are the leading cause (60%) of TBIs followed by falls (20%-25%) and violence (10%).It is also a known fact that the best facilities, equipment and skill sets in terms of emergency room, ICU facilities, neurosurgical skills and equipment cannot reverse damage sustained at scene of injury or enroute to hospital. Airway obstruction and aspiration are major cause of death in treatable head injuries. The aims of prevention of secondary brain injury can be met with only in pre-hospital settings. All these facts underscore the need for an efficient pre-hospital care management of head injuries. However, in India, till 2005, no comprehensive data has been available on this aspect of management, because there was no integrated comprehensive pre-hospital care providing service available. In 2005, Emergency Management and Research Institute (EMRI) was established, to take a lead role in providing pre-hospital care. We wish to share our experience and the findings in pre hospital management of Traumatic Brain Injuries(TBI).This is retrospective study of 1607 cases of traumatic brain injury handled by EMRI, in the state of Andhra Pradesh, from 01 Jan 08 to 31 Dec 08. Data captured on patient case report forms (PCR) for this segment of emergencies was reviewed. We studied various components of the data having a bearing on outcome, namely the social, demographic, clinical determinants, response times and outcome.The demographic determinants reveal that incidence of head injury in men is more than twice that in women. It is the people in prime of their age (21–45) who are affected most. The share of victims handled by EMRI shows a preponderance of economically deprived population amongst victims. Analysis of different risk factors revealed that systolic BP at scene and at hospital is significantly correlated with outcome. Paired sample T-test showing a 2-tailed significance of P<0.01at 95 % CI: 3.717–8.777, with T value of 4.843. GCS analysis revealed significant correlation with outcome at level of p<0.01, with Pearson's ‘R’ value of .071. Age of victim showed significant correlation at p<0.05 level with Pearson's R value of.087. SPO2 showed significant correlation with outcome with a significance at level of p < 0.01, and Pearson's ‘R’ value of 0.217. The mean response time was found to be statistically significant at p<0.05 level and a ‘Pearson's R’ value of .094. One way Anova studies showed distance to be significant at P< 0.05 level at 95 % CI: 16.56–43.35, with a f value of 4.376.It is evident from the study that the analysis of risk factors leading to establishing guidelines and protocols for pre hospital management of head injuries can definitely contribute to improving outcomes in TBI.

Helmets for Snow Sports: Prevalence, Trends, Predictors and Attitudes to Use

Traumatic head injury is the leading cause of mortality and serious morbidity in snow sports and is increasing in incidence. Helmet use in snow sports can reduce the incidence of head injury by up to 60%. Mandatory helmet use is not legislated in most recreational settings for snow sports. This study aimed to quantify the prevalence and trends of helmet use by skiers and snowboarders as well as to investigate predictors of helmet use and reasons why they are worn. A cross-sectional study including observation of skiers and snowboarders allocated to adult and child groups (5,267 persons), retrospective review of ski patrol accident report forms recorded between 2003 and 2008 (3,984), and completion of specially designed questionnaires by randomly approached snow sport participants (1,029). In 2008, 16% of adults and 67% of children wore helmets. Helmet use increased for adult and child participants between 2003 and 2008. Children, men, and snowboarders were significantly more likely to wear a helmet than their respective counterparts. Significant predictors of helmet use were level of experience, past major crash requiring medical assistance, snow sport lessons, and location of activity. Key reasons for helmet use and disuse were identified. Child helmet use far exceeded adult helmet use. Rates of voluntary helmet use are increasing but many remain unprotected from the benefits of a helmet. Identification of the snow sport participants least likely to wear a helmet and their reasons for not doing so should allow targeted helmet promotion and injury prevention strategies to reduce serious head injuries in snow sports.

Bicyclists Injured by Automobiles: Relationship of Age to Injury Type and Severity—A National Trauma Databank Analysis

Bicycle riding is a popular recreational activity and a common mode of transportation. Impact with a motor vehicle, however, has the potential to result in significant injury to the rider. The magnitude of this problem, the incidence and types of injuries, and the effect of age on these variables are poorly defined in the literature. This was a National Trauma Databank study during a 5-year period. Injury Severity Score (ISS), specific injuries sustained by riders, and outcomes were analyzed according to age groups (≤ 14 years, 15-35 years, 36-55 years, 56-65 years, and >65 years). During the study period, there were 12,429 admissions as a result of bicycle-related injuries involving motor vehicles (0.7% of all trauma admissions). There were 4,095 patients (32.9%) ≤ 14 years, 3,806 (30.7%) 15 to 35 years, 3,413 (27.5%) 36 to 55 years, 688 (5.5%) 56 to 65 years, and 427 (3.4%) >65 years. The incidence of severe or critical trauma (ISS ≥ 16) in the five age strata was 20.3%, 19.2%, 26.4%, 33.4%, and 38.2%, respectively (p < 0.001). The most commonly encountered injuries consisted of extremity fractures (34.9%). Patients ≤ 14 years old were significantly more likely to suffer fractures to the lower extremity and less likely to sustain fractures to the upper extremity. The overall incidence of head injury was 28.3% and increased in a stepwise fashion with increasing age, ranging from 26.5% in the age stratum 15 to 35 years to 38.6% in the age stratum >65 years, p < 0.001. The overall mortality was 3.7% and ranged from 2.4% in the age stratum ≤ 14 years, to 12.2% in the stratum >65 years. After adjusting for differences in age groups, there was a stepwise increase in the risk of death for bicyclists >65 years old who were 10-fold more likely to die than those ≤ 14 years old (adj. p < 0.001). Bicycle-related injuries involving motor vehicles are associated with a high incidence of head injuries and extremity fractures. Age plays a critical role in the severity and anatomic distribution of injuries sustained, with a stepwise increase in mortality with increasing age. Further evaluation of specific preventative measures, especially for elderly bicyclists is warranted.

Skateboard-Related Injuries: Not to be Taken Lightly. A National Trauma Databank Analysis

With the increasing popularity of skateboarding, trauma centers are experiencing increased number of skateboard injuries. The incidence and type of injuries and the effect of age on these variables are poorly described in the literature. Data from National Trauma Databank during a 5-year period was used for this study. Injury Severity Score (ISS), injured body area, specific injuries, and outcomes were calculated according to age groups (younger than 10 years, 10-16 years, and older than 16 years). During the study period, there were 2,270 admissions due to skateboard-related injuries (0.1% of all trauma admissions). There were 187 patients (8%) younger than 10 years, 1,314 patients (58%) 10 years to 16 years, and 769 patients (34%) older than 16 years. The overall mortality was 1.1% and ranged from 0% in the age group younger than 10 years to 0.3% in the group 10 years to 16 years and 2.6% in the group older than 16 years (p < 0.001). The incidence of severe trauma (Injury Severity Score ≥ 16) in the three age groups was 5.4%, 13.5%, and 23.7%, respectively (p < 0.001). The incidence of traumatic brain injury in the three age groups was 24.1%, 32.6%, and 45.5%, respectively (p < 0.001). The younger age group (younger than 10 years) was significantly more likely to suffer femur fractures and less likely to suffer tibia fractures than the older age groups. Helmets and use of a skateboard park were significant factors protecting against head injury. Skateboard-related injuries are associated with a high incidence of traumatic brain injury and long bone fractures. Age plays an important role in the anatomic distribution of injuries, injury severity, and outcomes. Our findings demonstrate that helmet utilization and designated skateboard areas significantly reduce the incidence of serious head injuries.

BokSmart: Pre-participation screening of rugby players by coaches based on internationally accepted medical standards

A comprehensive medical history forms a significant part of any medical assessment or screening. In the athlete, pre-participation screening is aimed at determining those aspects of personal and family history that place the participant at greater risk of sudden death, serious illness or musculoskeletal injury. In rugby union, where the incidence of head and neck injuries is higher than in other sports, emphasis needs to be placed on screening for potential risk factors for neurological injury. In a South African rugby environment, pre-season medical screening is not standard and indeed rarely practised. In most club and school settings, the rugby coach may well be the person most in contact with players and therefore in the best position to conduct an initial screening. This article reviews the relevant literature pertinent to such a guideline.

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.

A functional data analysis approach for modelling and predicting injury incidence rates: An application to falls

To date, much falls epidemiology data describing the magnitude of, and trends in, the problem has largely been descriptive in nature. It is important that good statistical models are used...

Helmets for snow sports in Australia: prevalence, predictors, recent trends and attitudes of use

BackgroundTraumatic head injury is the leading cause of mortality and serious morbidity in snow sports and is increasing in incidence. Helmet use in snow sports can reduce incidence of head...

Resource utilization and outcomes of intoxicated drivers

BackgroundThe high risk behavior of intoxicated drivers, impaired reaction time, lack of seat belt use, and increased incidence of head injury raises questions of whether pre-hospital use of alcohol leads to a higher injury severity score and worse clinical outcomes. We therefore compared intoxicated and non-intoxicated drivers of motor vehicle crashes with respect to outcome measurements and also describe the resources utilized to achieve those outcomes at our Level 1 trauma center.MethodsRetrospective descriptive study (Jan 2002-June 2007) of our trauma registry and financial database comparing intoxicated drivers with blood alcohol levels (BAC) > 80 mg/dl (ETOH > 80) with drivers who had a BAC of 0 mg/dl (ETOH = 0). Drivers without a BAC drawn or who had levels ranging from 1 mg/dL to 80 mg/dL were excluded. Data was collected on demographic information (age, gender, injury severity score or ISS), outcome variables (mortality, complications, ICU and hospital LOS, ventilator days) and resource utilization (ED LOS, insurance, charges, costs, payments). Statistical analysis: p < 0.05 vs. ETOH > 80; stratified chi square.ResultsOut of 1732 drivers, the combined study group (n = 987) of 623 ETOH = 0 and 364 ETOH > 80 had a mean age of 38.8 ± 17.9, ISS of 18.0 ± 12.1, and 69.8%% male. There was no difference in ISS (p = 0.67) or complications (p = 0.38). There was a trend towards decreased mortality (p = 0.06). The ETOH = 0 group had more patients with a prolonged ICU LOS (≥ 5 days), ventilator days (≥ 8 days), and hospital LOS (> 14 days) when compared to the ETOH > 80 group (p < 0.05). The ETOH > 80 group tended to be self pay (4.9% vs. 0.7%, p < 0.5) and less likely to generate payment for hospital charges (p < 0.5). Hospital charges and costs were higher in the ETOH = 0 group (p < 0.5).ConclusionsThe data suggests that intoxicated drivers may have better outcomes and a trend towards reduced mortality. They appeared to be less likely to have prolonged hospital LOS, ICU LOS, and ventilator days. We also observed that intoxicated drivers were more likely to be self-pay, less likely to have charges > $50K, and less likely to pay ≥ 90% of the charges. Further research using multivariable analysis is needed to determine if these apparent outcomes differences are driven by acute intoxication, and the tendency for endotracheal intubation and ICU admission, rather than injury severity.

Finite element modelling of equestrian helmet impacts exposes the need to address rotational kinematics in future helmet designs

Jockey head injuries, especially concussions, are common in horse racing. Current helmets do help to reduce the severity and incidences of head injury, but the high concussion incidence rates suggest that there may be scope to improve the performance of equestrian helmets. Finite element simulations in ABAQUS/Explicit were used to model a realistic helmet model during standard helmeted rigid headform impacts and helmeted head model University College Dublin Brain Trauma Model (UCDBTM) impacts. Current helmet standards for impact determine helmet performance based solely on linear acceleration. Brain injury-related values (stress and strain) from the UCDBTM showed that a performance improvement based on linear acceleration does not imply the same improvement in head injury-related brain tissue loads. It is recommended that angular kinematics be considered in future equestrian helmet standards, as angular acceleration was seen to correlate with stress and strain in the brain.