Minor Head Research Articles

Defining futile and potentially avoidable interhospital trauma transfers

PurposeInterhospital transfer of critically injured patients to a major trauma service reduces preventable death in major trauma. Yet some of those transferred die without intervention. These ‘futile’ interhospital trauma transfers (IHTs), and other potentially avoidable IHTs place enormous stress on families of trauma victims, can delay care, and incur great cost to public health resources. This study sought to characterise these IHTs using current state guidelines for interhospital transfer. MethodsA retrospective cohort study was conducted using our institution's trauma registry from January 2016–December 2020. All adult patients transferred to our major trauma service were analysed. Futile IHTs were defined as death or transfer to hospice care without surgical, endoscopic, or radiological intervention, and without ICU admission, within 72 h of admission. Potentially avoidable IHTs were defined as all patients discharged alive without intervention or ICU care, and secondary over-triage patients are a subset of these patients who were discharged within 72 h of admission. Patient demographics, injuries, and treatments were categorised from electronic records and analysed. ResultsOf 2,837 IHTs, seven (0.2 %) met criteria for futility. The majority were female, median age of 80 (IQR 85–75) and had a median Injury Severity Score (ISS) of 16 (IQR 25.5–11.5). By contrast, 1391 patients (49 %) were classified as potentially avoidable and 513 (18 %) were considered secondary over-triage. The majority were male, median age of 43 (IQR 62–28), and had a median ISS of 9 (IQR 13–4). Of these potentially avoidable IHTs, 984 (70.7 %) were discharged directly home. ConclusionFutile IHTs were infrequent, however over half of all trauma patients transferred from other hospitals were discharged without tertiary-level intervention. Trauma services should consider developing systems such as telehealth to support regional general and orthopaedic surgeons to co-manage lower risk trauma, particularly minor head and minor spinal trauma patients. This could be an integral part of safely reducing potentially avoidable IHTs and their associated costs while maintaining a low rate of preventable mortality in trauma.

Differences in presentation, treatment, and outcomes among minority head and neck cancer patient groups in Los Angeles County

ImportanceWhile minorities represent around 20 % of all HNC patients, these demographics are largely understudied. Furthermore, trends in national studies may not always be fully replicated in locoregional populations, indicating a need for more nuanced study. ObjectiveTo better understand our patient population, we sought to understand differences in presentation, management, and outcome between Caucasians and minority groups with HNC. DesignRetrospective cohort analysis of the Los Angeles County Surveillance Epidemiology and End Results (SEER) database. SettingLos Angeles County. ParticipantsAll patients in Los Angeles County diagnosed with cancer of the head and neck from January 1, 1988 to December 31, 2018. Main outcomes and measuresThe primary outcome in our study was significant differences between racial and ethnic groups in age of diagnosis, sex, socioeconomic quintile, insurance status, stage at diagnosis, treatment modality, time to first treatment, and cancer-specific cause of death. ResultsOur 18,510-patient cohort was largely male (64.35 %), white (69.57 %), and were on average 62.84 years old (SD = 20.07). When stratifying patients by race and ethnicity, significant differences were found in average age at diagnosis, sex, socioeconomic quintile, insurance status, and stage at diagnosis, treatment modalities utilized, and time to first treatment (all p < 0.001). Relative to all other head and neck patients, minority groups were significantly younger, had lower proportions of male patients, were less likely to pursue surgery, were more likely to pursue chemotherapy or radiation, and endorsed longer time to first treatment (all p < 0.001). The distribution of socioeconomic quintile (all p < 0.001), insurance status (all p < 0.001), and stage at diagnosis (all p < 0.05) also significantly varied between minority and reference groups. Only African Americans exhibited significantly higher rates of cancer-specific cause of death relative to non-African Americans (p < 0.001). Conclusions and relevancePervasive socioeconomic disparities between Caucasian HNC patients and those of other minority racial and ethnic groups in Los Angeles County that likely and significantly impact the diagnosis and management of HNC and its resultant outcomes. We encourage others to similarly examine their local populations to tailor the quality of care provided to patients.

Pediatric sport and exercise medicine: Eight things clinicians and patients should question.

Choosing Wisely Canada (CWC) is the national voice for reducing unnecessary tests and treatments in Canada. A small working group created by the Canadian Academy of Sport and Exercise Medicine developed a list of pediatric sport and exercise (SEM) recommendations based on existing research, experience, and common practice patterns. These recommendations identify tests and treatments commonly used in pediatric musculoskeletal assessments that are not supported by evidence and could expose patients to harm. Iterative feedback from key stakeholders informed the final list. The final list comprises eight recommendations including imaging recommendations for Osgood Schlatter's disease, shoulder and knee injuries, back pain, scoliosis, spondylolysis, distal radial buckle fractures, minor head injury/concussion, and management of chronic pain syndromes. Adopting these CWC pediatric SEM recommendations as part of routine practice may optimize care and minimize unnecessary investigations and treatments.

Atlantoaxial Rotary Subluxation in Marfan Syndrome

Atlantoaxial rotary subluxation (AARS) is a rare condition that may cause persistent torticollis if not treated appropriately. AARS is associated with ligamentous abnormalities, which may result from acquired or congenital disorders. We report the case of a paediatric patient with congenital Marfan syndrome and AARS due to a minor traumatic head injury. A 9-year-old boy with a known diagnosis of Marfan syndrome (and extensive family history) encountered a traumatic head injury that presented as torticollis with a typical “cock-robin” head and neck orientation. AARS was diagnosed through a head and neck CT scan. He underwent initial conservative treatment involving a muscle relaxant (diazepam) and Miami-J collar. This was followed up with manipulation under anaesthesia (MUA) and further cervical traction, which resolved the subluxation without more invasive treatment. To the best of our knowledge, AARS associated with Marfan syndrome has been rarely reported in literature. It is postulated that the ligamentous laxity associated with Marfan syndrome would increase the patient’s predisposition to AARS and more importantly, the propensity to require more invasive treatment (internal fixation). However, our patient unexpectedly responded well to conservative management, namely MUA and cervical traction. This illustrates that despite the increased ligamentous laxity in Marfan syndrome, it is still advisable to conservatively manage AARS before deciding to perform invasive internal fixation.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S15

The Importance of Scalp Hematoma in Predicting Intracranial Injury in Elderly Patients with Minor Blunt Head Trauma

The Importance of Scalp Hematoma in Predicting Intracranial Injury in Elderly Patients with Minor Blunt Head Trauma

Implementing Electronic Health Record-Based Clinical Decision Support for Head CT Ordering in Minor Pediatric Head Trauma.

Implementing Electronic Health Record-Based Clinical Decision Support for Head CT Ordering in Minor Pediatric Head Trauma.

Codesigning discharge communication interventions with healthcare providers, youth and parents for emergency practice settings: EDUCATE study protocol

IntroductionDischarge communication is an important aspect of patient care but frequently has shortcomings in emergency departments (EDs). In a paediatric context, youth or parents with young children often leave the...

Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children

BackgroundHead trauma in children is common, with a low rate of clinically important traumatic brain injury. CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee derived new guidelines for the initial management of minor and moderate head trauma. Our aim was to validate these guidelines.MethodsWe applied the guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the study: “Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study” by Kuppermann et al. (Lancet 374(9696):1160–1170, https://doi.org/10.1016/S0140-6736(09)61558-0, 2009). We calculated the negative predictive values of the guidelines to assess their ability to distinguish children without clinically-important traumatic brain injuries and traumatic brain injuries on CT scans, for whom CT could be omitted.ResultsWe analysed a population of 43,025 children. For clinically-important brain injuries among children with minimal head injuries, the negative predictive value was 99.8% and the rate was 0.15%. For traumatic findings on CT, the negative predictive value was 96.9%. Traumatic finding on CT was detected in 3.1% of children with minimal head injuries who underwent a CT examination, which accounts for 0.45% of all children in this group.ConclusionChildren with minimal head injuries can be safely discharged with oral and written instructions. Use of the SNC-G will potentially reduce the use of CT.

Monotherapy Aspirin in Minor Traumatic Head Bleeds does not Worsen Outcome

Abstract INTRODUCTION Traumatic head bleeds (THBs) are one of the most common neurosurgical consults in the trauma/acute care setting. U.S. adults on monotherapy aspirin (mASA) are presumed to have increased risk for Worsened outcomes after THBs. It is crucial to understand the effect mASA has on THBs. METHODS A retrospective review of prospectively collected data on THBs at a single center from 2013 to 2018 collected age, BIG category, aspirin use and dose, Injury Severity Score (ISS), length of stay (LOS), and days in intensive care unit (ICU days). Please refer to the Brain Injury Guideline protocol as defined by the University of Arizona study. All patients were categorized according to their imaging alone. For example, a patient on mASA with an initial CT head of BIG 1 category is coded as “BIG 1a,” as opposed to “BIG 3,” per BIG brain injury guidelines. RESULTS A total of 630 patients (mean age 71.5 yr) were included. MASA use in BIG-1 and BIG-2 graded THBs did not increase LOS (P = .79; P = .159) and ICU days (P = .74; P = .089) when compared to non-aspirin counterparts. MASA use in BIG-1 and BIG-2 THBs has significantly shorter LOS (P &lt; .0001; P &lt; .0001) and fewer ICU days (P &lt; .0001; P &lt; .0001) when compared to BIG-3 counterparts. MASA use in BIG-1 and BIG-2 THBs resulted in lower ISS as compared to BIG-3 THBs (P &lt; .0001; P &lt; .0001). BIG-3 THBs on mASA had decreased ISS when compared to non-aspirin counterparts (P = .0001). There was no difference between BIG-2 THBs with or without mASA use (P = .353). CONCLUSION There is no significant increase in ISS, LOS, or ICU days in patients on mASA with THBs. Patients on mASA therapy behave similar hospital stays as compared to non-aspirin counterparts, requiring shorter hospitalization/ICU days.

Facilitating Positive Youth Development in Elite Youth Hockey: Exploring Coaches’ Capabilities, Opportunities, and Motivations

Youth sport has been identified as a viable means to facilitate positive youth development (PYD) and nurture fully prepared and contributing adults. However, questions have arisen regarding elite youth sport as a context to effectively foster PYD, and specifically the role of the coach in this process. To explore how coaches facilitate PYD in elite youth sport, the first author immersed himself in the elite youth hockey setting as an assistant coach. Using an ethnographic research design, he observed four AAA minor hockey head coaches of four teams in a large urban center in Ontario over the course of one season. In addition, each coach participated in two semistructured interviews. Framed within the COM-B model, we examined how coaches’ capabilities, opportunities, and motivations influenced their behaviors related to facilitating PYD. The coaches discussed and demonstrated several behaviors (e.g., setting high standards, providing leadership opportunities, communicating with the athletes) with the potential to facilitate PYD; however, the sport structure (i.e., professional sports model that focuses on competition and performance from early childhood) often restricted their ability to do so. Further, coaches’ own motivations to achieve performance success presented a challenge to fostering PYD on some occasions. The results are situated within PYD literature and may evoke practical considerations for elite youth sport coaches aiming to foster PYD more effectively. Lay summary: Four AAA minor hockey coaches were interviewed and observed over the course of a season. Although the coaches were capable and motivated when it came to fostering the personal development of their players, the performance-oriented structure of the minor hockey system meant that coaches often prioritized winning over player development.

Effect of Oral Administration of Selenium and Vitamin E on the Quality of Fresh, Refrigerated and Frozen Semen in French Bulldog Breed Dogs

Background: New methodologies have been developed seeking to maximize pregnancy rate in female dogs created in commercial kennels, and also in order to maintain the quality of canine semen after dilution, refrigeration or freezing. One of the main factors that generate damage to sperm is oxidative stress, to minimize sperm damage, selenium and antioxidants like vitamin E are administered, by oral administration, seeking to improve the quality of semen. The objective was to study the effect of vitamin E and selenium, by oral administration, in the quality of fresh, refrigerated and frozen semen in adult dogs French Bulldog breed.Materials, Methods &amp; Results: Semen samples were collected from 5 adult dogs, French Bulldog breed, being 2 semen drawing before the daily oral supplementation with vitamin E and selenium (ESE®) and semen drawing at 20, 40 and 60 days after the beginning of oral supplement. The ejaculated samples were diluted in TRIS - fructose citric acid (3.28 g TRIS-hydroxy-methyl-amino-methane, 1.78 g of citric acid monohydrate and 1.25 g of D - fructose, dissolved in 100 mL of distilled water and added of 20% egg yolk and 6% of glycerol. The characteristics evaluated in fresh semen were: volume (mL), color, appearance, concentration (x106 / mL), sperm motility (%), sperm strength (1 to 5) and morphology (%). For refrigerated and frozen semen were analyzed: sperm motility (%), sperm strength (1-5) and morphology (%). Diluted semen samples were centrifuged at: 1500 g/10 min and “pellets” formed by sperm of each ejaculated, detached from the tube wall were diluted homogeneously in the diluent TRIS type up to the final volume of 1.5 mL. After that, packaged in 0.5 mL French straws, kept under refrigeration at 5ºC/4 h, placed in nitrogen vapor at -120ºC/15 min, and dipped in liquid nitrogen at -196ºC and then stored on identified rachis and stored in liquid nitrogen container until the time of thawing in water bath at 37°C/30 s for semen microscopic analysis. Data from fresh, refrigerated and frozen semen were statistically analyzed by analysis of variance and the average compared by 5% of Tukey test. Fresh semen sperm concentration differed (P &lt; 0.05) between the samples, rising after 40 days after the beginning of oral supplementation with selenium and vitamin E. For the spermatic strength, better score (P &lt; 0.05) was observed at collection 4, in 40 days after the beginning of oral supplementation to dogs. For fresh and refrigerated semen, the total defects, defects of head, acrosome and tail did not differ (P &gt; 0.05) between the samples. Total sperm defects and minor head and tail defects did not differ (P &gt; 0.05) between the samples in post-thawing. Regarding the acrosome defects after thawing, there was a significant reduction (P &lt; 0.05) in samples performed 40 and 60 days after the beginning of oral supplementation with selenium and vitamin E.Discussion: Attention should be paid for what purpose the extenders within the refrigeration or freezing biotech will be used. The managed supplement, by oral administration, containing selenium and vitamin E, influenced beneficially raising the sperm concentration in fresh semen and decreasing the acrosome defects in frozen semen. Oral administration of supplementation with selenium and vitamin E is recommended for improving the quality of fresh and frozen semen in dogs.

Spontaneous Arterial Dissection—Risk Factors And Clinical Features: Study Of 70 Cases And Review Of Literature

Dissection refers to a serious condition that begin as a tear or rupture in the inner layers of large vessel wall. Tear allows the blood to surges through the layers, leads to intramural hematoma or an aneurysmal dilatation, either of which can be a source of thromboembolism. Ischemic symptoms in surrounding structures are more often secondary to embolism. Dissections are labeled spontaneous in the absence of major blunt or penetrating trauma. The incidence rates for spontaneous carotid artery dissection have been reported to be 2.5 to 3 per 100,000 population. The average annual incidence for vertebral artery dissection were calculated to be 1 to 1.5 per 100,000. Typical clinical features seen with dissection include unilateral headache, ipsilateral Homer's syndrome, oculosympathetic palsy, prominent neck and facial pain, retinal ischemia, and symptoms of focal brain ischemia due to the site of dissection. The reason of dissection occurrence is still unknown but numerous factors e.g. connective tissue disorders, hyperhomocystinemia, fibromuscular dysplasia, recent infection, etc. may underlie spontaneous or minor trauma dissections. Patients with Spontaneous dissection are more susceptible to developing to stroke and its morbidity and mortality. In this retrospective study, we evaluate the clinical features, risk factors, treatment and outcome of spontaneous dissection in 70 patients (31 female and 39 male), referred to Namazi hospital between September 2012 and September 2016. The diagnosis of arterial dissection was established by qualified physicians according to radiological and clinical features. Patients with traumatic dissection and a history of major or minor head and neck injury were excluded. Subjects were observed for multiple risk factors such as age dependent risk factors, family history of venous thrombosis, history of trauma, coagulopathies, infectious diseases, systemic disorders, arterio-venous malformations and autoimmune diseases. We also investigated for any history of OCP administration in female patients. The collected data was evaluated using SPSS 16. Chi-square test were performed for the comparison of qualitative variables. And p&lt;0.05 was considered as the level of significance in two-tailed tests. Statistical analysis of our data found a significant correlation between hypertension and occurrence of spontaneous arterial dissection. The findings confirm that hypertension, OCP administration and smoking can increase the risk of CVST significantly.

Decoding the Structure of Indias Union Budget

In the run up to 86th Union Budget of India (including interim budgets) presented in Feb 2016, this is a modest attempt to study and understand the structure of government accounts both on the revenue and expenditure side. The Constitution of India has clearly laid down the entire procedure for preparing the Union Budget and recording all the events both on the account of revenue and expenditure. The paper attempts to study the entire process of preparing a Budget in detail. It also studies the method of recording transactions under various major and minor heads. Deficit calculation is an integral part of government Budgets in developing countries. The paper concludes with the discussion on methods and types of Budget Deficits.

How nominal compounds are modified by two adjectives

Abstract Basing itself on a corpus of one thousand complex NPs, this study investigates the relationships that two attributive adjectives contract with the constituents of nominal compounds of varying size in English (e.g. new basic safety standards). Essentially, there are four logically possible relationships: (i) both adjectives modify the nominal head, (ii) both adjectives modify the nominal modifier, (iii) the first adjective modifies the head and the second adjective the modifier and (iv) the first adjective modifies the modifier and the second adjective the head (crossed modification). While options (i) and (iii) are strongly represented in the data, crossed modification is not at all present. Across all compound sizes, at least three factors shape the empirical patterns: a functional factor whereby major heads are more easily singled out than minor heads, which in turn are more available than modifiers; a structural factor whereby more deeply embedded constituents are less available than more independent constituents; and a proximity effect which encourages the modification of the first noun by the second adjective. There may be an additional saturation effect which discourages the modification of one noun by two adjectives. On the face of it, the non-occurrence of crossed modification may be connected to the well-known ban on crossing association lines. However, despite its descriptive adequacy, this principle is unconvincing. Instead, a functional explanation is proposed which centres on the possibility of working out modification relationships. Initial steps are taken towards developing a model of when (and why) the no-crossing constraint is inviolable, violable or non-existent

Minor Pediatric Head Trauma in the Emergency Unit

Minor Pediatric Head Trauma in the Emergency Unit

Nurse and Physician Agreement in the Assessment of Minor Blunt Head Trauma

The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) clinical prediction rules identify children with minor blunt head trauma who are at low risk for clinically important traumatic brain injuries. We measured the agreement between the registered nurse (RN) and physician (MD) assessments. We performed a cross-sectional study of all children <18 years of age with minor blunt head trauma who presented to a single emergency department. RNs and MDs independently assessed each child and recorded age-based PECARN predictors. As symptoms can change over time, we included cases only when both evaluations were completed within 60 minutes. We used the κ statistic to measure RN-MD agreement, with the main analysis focusing on the overall PECARN rule agreement. Of the 1624 eligible children, 1191 (73%) had evaluations completed by both RN and ED providers, of which 437 (37%) were in children <2 years of age. The median time between completions of the provider forms was 12 minutes (interquartile range 4-25 minutes). The overall agreement between the RN and MD was higher for the older children (κ 0.55, 95% confidence interval 0.49-0.61 for children 2-18 years versus κ 0.32, 95% confidence interval 0.23-0.41 for children <2 years). The overall agreement between RN and MD for the PECARN TBI prediction rules was moderate for older children and fair for younger children. Initial RN assessments should be verified by the MD before clinical application, especially for the youngest children.

Nurse and Physician Agreement in the Assessment of Minor Blunt Head Trauma

Nurse and Physician Agreement in the Assessment of Minor Blunt Head Trauma

To CT or Not to CT: Risks of Missed Brain Injury vs. Radiation Exposure in Young Children

Computed tomography (CT) imaging decisions for children <2 years of age with minor blunt head trauma must balance the risk of radiation-associated

Dens fracture in a patient with extensive craniocervical bone pneumatization

Craniocervical bone pneumatization in humans is very rare: only a handful of cases have been reported, predominantly in males (1). The characteristic air-filled bones are prone to fracture, even following minor trauma. Our case report (2) recently published in the December 2011 issue of Diagnostic and Interventional Radiology described abnormal extensive craniocervical bone pneumatization in a 47-year-old man; the same patient again presented to our hospital 10 months later with cervical pain after minor trauma (collapse). The patient complained of neck pain. No evidence of a neurological deficit was found. Initially performed plain radiographs of the upper cervical spine showed no evidence of a fracture. Because clinical symptoms persisted, we performed multislice computed tomography (MSCT) of the skull base and upper cervical spine using a 64-detector-row computed tomography (CT) scanner (Siemens Sensation 64, Siemens AG Sector Healthcare, Erlangen, Germany). Axial, coronal, and sagittal reconstructions were made using 0.75-mm slices. In addition to pre-existing extensive pneumatization of the skull base and atlas (Fig. a), submillimeter-scale axial images showed two thin lines at the dens at 7 and 9 o’clock (Fig. b), suspicious for thin fractures. In contrast to the previous CT findings (Fig. a), ambient soft-tissue emphysema could be observed on axial reconstructions (Fig. b, arrow). Although pre-trauma coronal reconstructions (Fig. c) showed pneumatization of the right hemicorpus of the axis, post-trauma MSCT depicted an Anderson and D’Alonzo Type III dens fracture (3) extending through the vertebral body of the axis (Fig. d, arrows). Patients who have been diagnosed with extensive craniocervical bone pneumatization need to be aware of the fragility of that anatomic region, and treating physicians should consider that even minor head or neck trauma may have serious consequences, such as fractures of the craniocervical region, in these patients. As reported earlier, the complex anatomy of the craniocervical region aggravates

The modification of compounds by attributive adjectives

This paper examines the modification of nominal compounds by attributive adjectives in English. It draws on a distinction between compound-external (i.e. syntactic) and compound-internal (i.e. morphological) modification. An analysis is presented of more than 1000 pertinent cases, which are roughly equally divided into two-, three- and four-noun compounds. Irrespective of their positions, all constituents of all compound sizes are found to be susceptible to modification. Modification is subject to two major parameters—functional role and depth of embedding. Major heads are much more accessible than minor heads which in turn are more accessible than modifiers. The greater the structural depth of a constituent, the lower the probability of it being modified. This pattern of results suggests that the adjective in compound-internal modification has access to the structure of the full compound. That is, morphological modification has a curious syntactic ring to it. This unexpected behaviour of the adjective blurs the distinction between syntactic and morphological modification and argues against the strict separation of syntax and morphology.