Management Of Head Injury Research Articles

Doctrine of ‘resipsa loquitur’ in surgical management of head injury in Transkei region, South Africa: Case Report

Background: Poor people accept death as ‘God’s wish’, sing a ritual song and bury their loved ones without pointing a finger at anyone or asking how their loved ones died. Medical errors cause several deaths, but most of the time this goes unnoticed, because many affected by it are poor and illiterate. Objective:To highlight the problem of fatal surgical errors in the management of head injury of patients in the Transkei region of South Africa. Case Histories: The case reports of the autopsies that discussed are intended to highlight the gross surgical negligence of medical professionals. In the first case, burr-holes were made to release intracranial pressure, but a piece of glass, which was the primary cause of increased intracranial pressure, was left in the cranium. In the second case, an inexperienced operating surgeon pushed the drill deep into the cortex of the brain while making burr-holes. The third case report describes a head injury suffered by an alcohol-intoxicated patient. The head injury was inflicted at a police station. This article presents histories, post-mortem findings, causes and mechanisms of death, as well as discusses acts of commission and omission. Conclusion: A high level of fatalities is caused by ‘acts of commission and omission’ in respect of head injury of patients in the Transkei region of South Africa. This matter needs regular auditing through forensic pathology services.

Diagnostic Neuroradiology in Head Injury

The 4th edition of the Guidelines for Treatment and Management of Head Injury by the Japan Society of Neurotraumatology newly published a three-step evaluation method for CT, indications for repeat CT, cancer risk associated with radiation exposure, and preparation of examination guidelines for reduction of radiation exposure. This manuscript describes how to proceed with diagnostic imaging of head injuries and the new items. The important points are as follows: •CT is the first-step diagnostic imaging method in the acute phase. •Initial CT assesses the presence or absence of intracranial hemorrhage requiring emergency craniotomy. •It is necessary to perform repeat CT to assess secondary injury. •For minor head injuries, the indication for CT should be determined by confirming neurological concomitant symptoms considering radiation exposure.

Registry-based pilot epidemiological study of traumatic brain injury in a tertiary trauma care center in Kerala, India - Difficulties encountered during data collection warranting the need for standardized electronic database.

Background: Head injury is referred to as a “silent epidemic” globally. Studies regarding epidemiology of head injury are very few especially in Kerala and most have conflicting reports. Unlike developed countries, there is no well-established system for collecting and managing information on traumatic brain injury (TBI) in India, especially in Kerala. The present study shares the difficulties encountered and the insights acquired by conducting a registry-based epidemiological pilot study for collecting a baseline data of traumatic head injury patients in a tertiary care center in Kerala.Methods: The pilot study was conducted to know the efficiency of present reporting system of a tertiary hospital in Kerala. We tried to collect retrospective data from December 2018 to December 2019 in the department of neurosurgery. As there was no standardized protocol or electronic database for data collection in hospital, we made a sample proforma for data collection. The patient details were obtained from medical records (case sheets), resident doctor’s, and staff nurse’s notes which included demography, clinical details, and radiological findings which were analyzed.Results: We were not able to fill the full details regarding demography, prehospital data, and clinicoetiological details which are important as far as head injury management is considered. The hospital records were grossly inadequate for full retrieval of information. Inadequate case definition and lack of centralized electronic reporting mechanisms were some of the major difficulties we faced obviating the need for collecting, managing, and utilizing epidemiological data using an electronic database.Conclusion: We believe that the present pilot study will give an insight regarding the difficulties encountered in collecting data regarding TBI. This study will be the first of its kind in Kerala highlighting the importance of maintaining a proper head injury electronic registry. The data from this study would definitely guide future experimental operational research on these unexplored areas which will be relevant in head injury policy-making in Kerala as well as in India.

Impact of implementation of the national institute for health and clinical excellence (NICE) head injury guideline in a tertiary care center emergency department: A pre and post-intervention study.

Head injury, a common presentation to the emergency department (ED), is a substantial problem in developing countries like Nepal. The current national institute for health and clinical excellence (NICE) guideline revised in January 2014 focuses on effective clinical assessment and early management of head injuries according to their severity in all age groups. This study assessed the impact of implementing this guideline on the proportions of computed tomography (CT) head scans, guideline adherence, and confidence level of the attending physicians. We consecutively recruited 139 traumatic head injury (THI) patients in this prospective pre-post interventional study conducted in the ED of a tertiary care center. We implemented the NICE guideline into routine practice using multimodal intervention through physicians' education sessions, information sheets and guideline-dissemination. The pre and post-implementation CT head scan rates were compared. The post-implementation guideline adherence was assessed. Online Google form-questionnaires including 12 validated case scenarios were distributed to the attending physicians at the end of both phases to assess their confidence levels. The implementation resulted in a statistically significant decrease in the proportion of CT head scan rates from 92.0% to 70.0% (p-value = 0.005). Following educational interventions, improved guideline adherence of 20.3 percentage points (p-value = 0.001) was observed. Nine ED attending physicians were enrolled in the study who showed statistically significant improvement in their confidence level following the intervention. The NICE guideline showed a sensitivity and specificity of 93.6% and 76.4% with 82.6% accuracy compared to that of clinical judgment (100%, 34.6%, and 58.1% respectively) in detecting intracranial lesions. The implementation was successful in satisfying the aim of the NICE guideline by decreasing the proportion of CT head scans, improving guideline adherence and increasing the confidence of the attending physicians.

To assess and analyze the clinical outcome of conservative and operative management of head injury in acute subdural haematoma

Traumatic acute subdural haematoma (SDH) continue to have high mortality & morbidity despite the advent of rapid transportation, CT Scan and Intensive care management. The general surgical procedures for Acute SDH is Craniotomy with removal of haematoma & decompressive craniectomy if necessary. This is a study based in department of surgery. After taking complete history and detailed examination and investigation (CT Scan) was be done. Decision of surgery was be taken by the consultant neurosurgeon of the acute Subdural Haematoma, involvement of aloquent areas and associated other injury of brain.200 patients with head injury who reported at casualty of Gandhi Medical College, and Hamidia Hospital, Bhopal.In our study, Mode of Injury found to be Assault were 20%, Fall were 27% & RTA 53% in Conservative whereas Assault were 06%, Fall were 14% & RTA 80%.The chi-square statistic is 96.3397. The p-value is < 0.00001. The result is significant at p < 0.05. These findings indicate that the thickness/size of acute SDH significantly correlates with the type of management to be done for the patient.Acute subdural haematoma is the major cause of significant morbidity and mortality due to traumatic head injury. Acute subdual haematoma is commonly associated with countercoup injuries and diffuse axonal injury (DAI). The clinical presentation in patients with acute SDH is related to raised ICP and the severity of DAI. C.T. Scan is the investigation of choice in patients with head injury.

Decision-making to stop or continue playing after football injuries - a systematic video analysis of 711 injury situations in amateur football

ABSTRACT Scientific injury registration via video analysis is lacking in amateur football. The purpose of this study was to analyse match injury situations with a focus on the decisions made by players and referees after sustaining a football trauma. In a retrospective cohort study, traumatic injuries sustained in any of the 305 matches of the highest amateur level (4th league) in Germany in the 2015–16 season were assessed by means of video analysis and a standardised video protocol. In total, 711 traumatic incidents at 919 different body regions had been recorded. The three most frequently injured body regions were the ankles (34.1%), the head (17.5%) and the knees (17.0%). 90% (n = 156) of head injuries were direct contact injuries, this percentage was significantly higher than that of contact injuries on ankle (68.4%; p < 0.001) or knee (52.6%; p = 0.001). Referees decided on foul play significantly more often in case of knee injuries (57.1%; p = 0.002) or ankle injuries (64.5%; p < 0.001) than in head injuries (39.8%). Only 26.1% of players with a head injury opted for substitution, which was lower than after ankle (27.8%; p = 0.78) and knee injuries (34.0%; p = 0.13). In conclusion, amateur football is associated with a considerable number of injury situations that are followed by match interruptions and the substitution of players. Players and referees decided to continue playing more often after a head injury than after an injury to other body regions. An advanced education programme on the risks and management of head injuries in football is required to prevent long-term health consequences.

A novel approach to explore Safety-I and Safety-II perspectives in in situ simulations\u2014the structured what if functional resonance analysis methodology

ObjectivesWith ever increasingly complex healthcare settings, technology enhanced simulation (TES) is well positioned to explore all perspectives to enhance patient safety and patient outcomes. Analysis from a Safety-II stance requires identification of human adjustments in daily work that are key to maintaining safety. The aim of this paper is to describe an approach to explore the consequences of human variability from a Safety-II perspective and describe the added value of this to TES.MethodsThe reader is guided through a novel application of functional resonance analysis methodology (FRAM), a method to analyse how a system or activity is affected by human variability, to explore human adaptations observed in in situ simulations (ISS). The structured applicability of this novel approach to TES is described by application to empirical data from the standardised ISS management of paediatric time critical head injuries (TCHI).ResultsA case series is presented to illustrate the step-wise observation of key timings during ISSs, the construction of FRAM models and the visualisation of the propagation of human adaptations through the FRAM models. The key functions/actions that ensure the propagation are visible, as are the sequelae of the adaptations.ConclusionsThe approach as described in this paper is a first step to illuminating how to explore, analyse and observe the consequences of positive and negative human adaptations within simulated complex systems. This provides TES with a structured methodology to visualise and reflect upon both Safety-I and Safety-II perspectives to enhance patient safety and patient outcomes.

The Role of Computed Tomography in Management of Minor Head Injury

Trauma is the main reason of death and various kinds of disability in pediatric population. Minor head injury has been described as a trauma that lead to physiological disorder of brain function and the symptoms may include altered in mental status that may be or may not be associated with loss of consciousness. furthermore, the expression (concussion) has been sometimes used to refer to the same cases. in general, minor head injury case is diagnosis of exclusion and may be possible to achieve final diagnosis after adequate observation and perform appropriate imaging studies [1].

Effectiveness of Multimodal Package on First aid Management of Head injury upon the Knowledge and Practice among Traffic Police at selected Traffic zones, Tamilnadu: A True Experimental Study

Effectiveness of Multimodal Package on First aid Management of Head injury upon the Knowledge and Practice among Traffic Police at selected Traffic zones, Tamilnadu: A True Experimental Study

Survival Rate Prediction of Head Injury Patients with Peripheral Oxygen Saturation

Good management of head injuries can improve patient survival. Examination of peripheral oxygen saturation (SpO2) is a procedure performed at the primary survey. This study aims to predict the survival rate of head injury patients with the SpO2 value. The method used was a prospective study with a cohort design. Samples were head injury patients who came to the ER without comorbidities. The instruments used were the Revised Trauma Score (RTS) and Oximetry. Patients who arrived at the ER were measured for their SpO2 levels, treated according to SOP, and 6 hours later, the survival rates were assessed. The sampling technique used was purposive sampling. The statistical test used is Somers’d Correlation Test. The sample consisted of 46 head injury patients with SpO2 in a good category of 30 (65.2%) and good survival of 32 (69.6%). SpO2 had a strong correlation with survival (p = 0.00; r = 0.846; RR = 8.16). Patients with good SpO2 were 8.16 times more survive than others. Low SpO2 can be used as an early indicator of tissue hypoxia and related to mortality. The ER nurse should be concerned about the patient's oxygen saturation and ensure that the SpO2 level is in the 95% -100% range.

The management of pediatric severe traumatic brain injury: Italian Guidelines.

The aim of the work was to update the "Guidelines for the Management of Severe Traumatic Brain Injury" published in 2012, to reflect the new available evidence, and develop the Italian national guideline for the management of severe pediatric head injuries to reduce variation in practice and ensure optimal care to patients. MEDLINE and EMBASE were searched from January 2009 to October 2017. Inclusion criteria were English language, pediatric populations (0-18 years) or mixed populations (pediatric/adult) with available age subgroup analyses. The guideline development process was started by the Promoting Group that composed a multidisciplinary panel of experts, with the representatives of the Scientific Societies, the independent expert specialists and a representative of the Patient Associations. The panel selected the clinical questions, discussed the evidence and formulated the text of the recommendations. The documentarists of the University of Florence oversaw the bibliographic research strategy. A group of literature reviewers evaluated the selected literature and compiled the table of evidence for each clinical question. The search strategies identified 4254 articles. We selected 3227 abstract (first screening) and, finally included 67 articles (second screening) to update the guideline. This Italian update includes 25 evidence-based recommendations and 5 research recommendations. In recent years, progress has been made on the understanding of severe pediatric brain injury, as well as on that concerning all major traumatic pathology. This has led to a progressive improvement in the clinical outcome, although the quantity and quality of evidence remains particularly low.

Neurosurgery in perilous area; is there any role of specialized field hospital in the management of low velocity penetrating head injuries?

Back ground: Surgery for patient with penetrating head injury during war is debatable in literature. Field hospital with limited resources in war area could have a role in the management of this less devastating head injures patients. Methods: During a 6 months of Syrian civil war (October 2012- March 2013), 30 patients with low velocity penetrating head injuries was referred to a 3 different field hospitals managed by the same surgical team. The patient inclusion criteria were including Glasgow coma scale (GCS) ranged from 11 to 15, whom didn’t need for neuroscience intensive care unit (NICU) admission. Patients had laboratory and image before management decision. After surgery, the patient had short term admission before discharge and follow up at outpatient clinic. Results: The mean age for civil war victim was 26. ± 10.1and most of cases were males. All cases had penetrating metal shrapnel injuries from barrel bomb explosion. The majority of cases had GCS =15 (43.3%). Frontal lobe was the most frequent affected lobe (53.3%). The most frequent CT finding was contusion, edema and mass effects (60%). Surgery was reported in (83.3%) with no reported mortality. Surgical outcome was affected by pre hospital chronic illness P= 0.04 and, numbers of affected brain lobes by penetrating metal (P= 0.001). Conclusion: Surgical outcome of penetrating head injuries patients can be affected number of the affected brain lobes by penetrating metal and bone fragments. Field hospital in war area could be valid in the management of such patient.

Severe Head Injury Management at a Tertiary Care Hospital in Dhaka City

Background: Severe traumatic brain injury can be a serious condition.&#x0D; Objective: The purpose of the present study was to see the decompressive craniectomy (DC) of severe traumatic brain injury.&#x0D; Methodology: This clinical trial was conducted in the Department of Neurosurgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2012 to December 2013 for a period of two (02) years. Patients with the age of 18 years and above, GCS of the patients 8 to 4, severe traumatic brain injury (TBI) with multiple hemorrhagic contusions and midline shift, on CT scan and severe TBI with gradual neurological deterioration were included for this study. Total 60 patients were included.&#x0D; Result: A total of 60 patients were included in this study. Almost two third 18 (60.0%) patients had favorable outcome (GOS 4 and 5) in group A and exactly two third 20(66.7%) patients had Unfavorable outcome (GOS 1,2 and 3) in group B (p&lt;0.05). In this study 8 patient died among which 5 had GCS 4 and 3 had GCS 5. One patient with GCS 5 became persistent vegetative. Eight patient with good recovery had GCS 8, 7 and 6. Death occurred at mean GCS 9±2.mm of midline shift followed by 8± mm in persistent vegetative, 5.67±2.08 mm in severe disability, 4.5±2.88 mm in moderate disability and 3.38±1.06 mm in good recovery.&#x0D; Conclusion: Group A had better clinical outcome than group B. So based on statistical analysis it can be concluded that DC is preferable to conservative management in case of severe TBI.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 124-128

The The Correlation of Hemodynamic Status and Oxygen Saturation with The Level of Consciousness in Head Injury Patients

Introduction: Head injury is a traumatic disorder caused by the mechanical strength of a blunt object or penetration that can cause temporary or permanent changes in tissue function and structure. The latest developing concept on poor prognosis among head injury patients was occur related to the secondary injuries, where there was an increase in intracranial, cerebral ischemia, and decreased consciousness. The important thing in the management of head injuries is to maintain hemodynamic stability and to prevent hypoxia by maintaining oxygen saturation &gt;95%. The purpose of this study was to analyze the correlation of hemodynamic status and oxygen saturation with the level of consciousness in head injury patients at RSUD Mardi Waluyo, Blitar.&#x0D; Methods: The research used correlational analytical with a cross-sectional design. The sampling technique used consecutive sampling within a total sample of 30 respondents. Spearman's test was used for data analysis.&#x0D; Results: The results showed a correlation between mean arterial pressure (p-value = .004), respiratory rate (p-value = .000), body temperature (p-value = .017), and oxygen saturation (p-value = .000) with level of consciousness (GCS) respectively.&#x0D; Conclusion: It can be concluded that mean arterial pressure, respiratory rate, body temperature, and oxygen saturation can affect the level of consciousness (GCS). There was a need to improve hemodynamic and oxygen saturation monitoring to prevent the bad prognosis in head injury patients at RSUD Mardi Waluyo, Blitar.

A Foundational "Survival Guide" Overview of Sports-Related Head Injuries.

Around 3.8 million traumatic brain injuries (TBI) occur every year from athletic participation. The signs and symptoms of each specific head injury can be difficult to delineate. Further, treatment for each injury varies significantly. While most sports-related head injuries are not life-threatening, prompt recognition of acute head injury with expedited care leads to better outcomes. Current medical education lacks in awareness of common sports-related head injuries and the acute management of these injuries. Due to this, a literature review was originally crafted to provide medical students with a brief education in the recognition, diagnosis, and acute management of sports-related head injuries. The objective is to provide a “survival guide” style of reference for medical students, but may also be useful for all primary care providers, first line responders, and athletic trainers. Current guidelines and primary studies were investigated to delineate common head injuries and their associated medical management. With this data, we developed a brief, overview regarding common head injuries that occur in sport-related activities. In addition to listing the most common brain injuries, we elaborate on how to develop acute care plans specific to each type of injury. The treatment plans could be enhanced via stratification into sex and age subcategories, as well as through studies including data regarding long-term observation.

Accidental Placement of Nasogastric Tube into the Brain: Case Report and Review of the Literature

AbstractThe nasogastric tube (NGT) plays a very vital role in the early resuscitation of head injury patients for various reasons. Though considered a simple procedure, it can be associated with multiple dreadful complications. Our patient was a 44-year-old male, referred from a peripheral health center for further management of severe head and faciomaxillary injuries following a motor vehicular accident. On arrival at the hospital, the endotracheal tube and NGT were in situ. A computed tomography scan of the brain revealed the NGT piercing through the cribriform plate of ethmoid and coiling into the cranial cavity with pneumocephalus. The NGT was retrieved under C-arm guidance and his injuries were managed respectively. The patient was discharged after prolong hospitalization with an acceptable outcome. With this case report, we want to remind emergency health care providers to avoid this catastrophic complication of NGT insertion in a faciomaxillary trauma patient by doing it transorally. We report a novel method of safely removing NGT which has not been reported in the past.

Management Dilemmas in Patients with Traumatic Brain Injury on Anticoagulants

Abstract Introduction A normal individual with normal hemostasis maintains a balance between thrombus formation and destruction using a complex interaction between the smooth vascular endothelium, the coagulation cascade, the platelet aggregation system, and the fibrinolysis mechanism. However, in patients who are on either antiplatelet drugs (APDs) or anticoagulants (ACDs), this normal homeostasis is altered. This is further altered with traumatic brain injury (TBI) and thus, we need specific guidelines to address this subpopulation to decide the length of observation, avoid unnecessary hospitalization, and relieve the economic burden. There exists a very few randomized controlled trials (RCTs) for this clinical question and a thorough risk–benefit analysis for each patient is prudent before making clinical decisions. Materials and Methods This is a review article based on available evidence published in literature. Results There are multiple therapeutic drugs which act on various stages of the coagulation mechanism. These include antiplatelet agents, Vitamin K antagonists, Heparin, Antithrombin III, and Glycoprotein IIb/IIIA inhibitors. While the initial management of head injuries depends on the severity of head injuries, management of head injuries in patients on anticoagulants needs to be approached with care and caution. There are multiple dilemmas including role of CT scans, duration and reason for admission, when to restart anticoagulation, etc. We suggest the recommendations based on available literature; however, no evidence can be given as these are not based on any RCTs, due to paucity of such studies. Conclusion The guidelines are based on previously conducted trials and consensus. We have attempted to provide a pragmatic and practical approach to such cases with the hope that it will ensure minimum risks with the best possible patient outcomes. The entire journey from patient presentation to follow-up has been covered in this article and we hope this would be useful to all practicing in the field of neurotrauma.

Recommendations for initial examination, differential diagnosis, and management of concussion and other head injuries in high-level football.

Head injuries can result in substantially different outcomes, ranging from no detectable effect to transient functional impairments to life‐threatening structural lesions. In high‐level international football (soccer) tournaments, on average, one head injury occurs in every third match. Making the diagnosis and determining the severity of a head injury immediately on‐pitch or off‐field is a major challenge for team physicians, especially because clinical signs of a brain injury can develop over several minutes, hours, or even days after the injury. A standardized approach is useful to support team physicians in their decision whether the player should be allowed to continue to play or should be removed from play after head injury. A systematic, football‐specific procedure for examination and management during the first 72 hours after head injuries and a graduated Return‐to‐Football program for high‐level players have been developed by an international group of experts based on current national and international guidelines for the management of acute head injuries. The procedure includes seven stages from the initial on‐pitch examination to the graduated Return‐to‐Football program. Details of the assessments and the consequences of different outcomes are described for each stage. Criteria for emergency management (red flags), removal from play (orange flags), and referral to specialists for further diagnosis and treatment (persistent orange flags) are provided. The guidelines for return to sport after concussion‐type head injury are specified for football. Thus, the present paper presents a comprehensive procedure for team physicians after a head injury in high‐level football.

Prioritizing Pediatricians' Neurosurgical Education: Results From a National Survey of Primary Care Pediatricians.

Introduction. We surveyed nonretired American Academy of Pediatrics-member US pediatricians regarding common neurosurgical conditions, identifying specific areas of focus in education. Methods. Data were acquired via self-administered electronic questionnaire. Results. Of 505 total respondents, 56% reported neurology was not a required residency rotation, and 86% had diagnosed craniosynostosis, plagiocephaly, or macrocephaly. Craniosynostosis can mostly be diagnosed by physical examination alone, but almost 50% reported relying on skull X-rays. Fifty-four percent reported diagnosing ocular surface disease (OSD; with 15% to 40% not screening an infant despite well-established cutaneous markers). Seventy-four screened OSD in a patient with sacral dimple. Ninety-seven percent reported treating concussion, but nearly 25% did not manage these patients alone. Two out of 3 patients indicated head injury as most important for continuing education. Conclusion. Improved education for craniosynostosis, OSD, head injury, and concussion management are important for earlier diagnosis, management, and referral of some disorders, while decreasing resource utilization in others. These results should be used when considering pediatrician educational programs.

Searching for a traumatic brain injury biomarker to aid clinical decision making in the emergency department.

The need for objective prognostic biomarkers to help in the clinical management of head injury is huge: missed diagnoses and different injuries and susceptibilities limit efforts to predict consequences, advise victims, and offer useful prognosis. Most traumatic brain injury (TBI) is represented by concussion or mild TBI, for which there are no simple, objective, reliable tests [1]. The long-term consequence of chronic traumatic encephalopathy (CTE) [2] is not currently predictable except from awareness that repetitive trauma from contact sports increases risk [3].