Severe Head Research Articles

Preventing and Investigating Horse-Related Human Injury and Fatality in Work and Non-Work Equestrian Environments: A Consideration of the Workplace Health and Safety Framework.

Simple SummaryAttempts to reduce horse-related injuries and fatalities to humans have mostly focused on personal protective equipment like helmets. In organizational contexts, such technical interventions are considered secondary to reducing the frequency and severity of accidents. In this article, we describe the Workplace Health and Safety (WHS) framework that has been associated with reduced risks in industries and organisations. We consider how such a framework could be used to reduce horse-related risks in workplaces, as well as non-work equestrian competition and leisure environments. In this article, we propose that the simplicity and concepts of the WHS framework can provide risk mitigation benefits to both work and non-work equine identities.It has been suggested that one in five riders will be injured due to a fall from a horse, resulting in severe head or torso injuries. Attempts to reduce injury have primarily focussed on low level risk controls, such as helmets. In comparison, risk mitigation in high risk workplaces and sports is directed at more effective and preventative controls like training, consultation, safe work procedures, fit for purpose equipment and regular Workplace Health and Safety (WHS) monitoring. However, there has been no systematic consideration of the risk-reduction benefits of applying a WHS framework to reducing horse-related risks in workplaces, let alone competition or leisure contexts. In this article, we discuss the different dimensions of risk during human–horse interaction: the risk itself, animal, human and environmental factors and their combinations thereof. We consider the potential of the WHS framework as a tool for reducing (a) situation-specific hazards, and (b) the risks inherent in and arising from human–horse interactions. Whilst most—if not all—horses are unpredictable, the majority of horse-related injuries should be treated as preventable. The article concludes with a practical application of WHS to prevent horse-related injury by discussing effective evidence-based guidelines and regulatory monitoring for equestrian sectors. It suggests that the WHS framework has significant potential not only to reduce the occurrence and likelihood of horse-related human accident and injury, but to enable systematic accident analysis and investigation of horse-related adverse events.

A comparable study of the diagnostic performance of orbital ultrasonography and CBCT in patients with suspected orbital floor fractures.

To compare the diagnostic performance of ultrasonography and CBCT against CT in detecting orbital floor fractures. A total of 120 orbits with clinical suspicion of isolated orbital floor fractures underwent multislice CT scanning with coronal reconstruction; orbital ultrasonography using a standard machine equipped with a 7- to 10-MHz linear transducer; and CBCT. Patients with severe head and face injuries were not included. The diagnostic performance of ultrasonography and CBCT was reported assuming conventional CT as the imaging method of choice. According to CT findings, fractures of the floor were present in 39 orbits. The sensitivity, specificity, positive-predictive value and negative-predictive value of ultrasonography in detecting orbital floor fractures were 87.2%, 100%, 100% and 94.2%, respectively. The corresponding values for CBCT were 97.4%, 97.5%, 95.0%, and 98.8%, respectively. Areas under the receiver operator characteristics curves of orbital floor fracture detection were 0.94 for ultrasonography and 0.98 for CBCT. When conventional CT cannot be performed in patients with clinically suspected orbital floor fracture and no severe or complex head and face injuries, CBCT could be used in detecting fractures as a reliable surrogate. Because of a lower sensitivity of ultrasonography, however, its use is limited in this regard.

국내 구급차량의 운행 중 사고 분석에 관한 조사 연구

The purpose of this study is to investigate the circumstances surrounding collisions involving ambulances with an aim to improving the safe operation of emergency services. Collisions are relatively common within paramedic emergency services. We analyzed the time, injury site, and any other specific factors of 908 collisions occurring within four cities. Within our study 29.6% of paramedics have been involved in accidents while responding to an emergency call, with the main cause of the accident being signal violation (35.7%), and is the other party's negligence (22.2%). 92.1% of these accidents occurred while the emergency lights were being operated. XX% of accidents took place in the afternoon, while xx% took place within the hours of xx:xx and xx:xx, during which time there is generally lower levels of traffic, which can cause severe brain and neck damage of 14.4% but the other part is 62.1%. (Ed note; this is not clear at all. 14.4% of collisions resulted in severe head and neck injuries, while 23.5% of collisions resulted in no injury. According to the respondents, defensive driving (xx%), observance of traffic laws (xx%), safe driving habits (xx%)to paramedics were the most critical factors in evading collision. Signal passes were identified as the most common cause of collision (70.1%). Although the majority of collisions occurred while the emergency lights were operational, the damage can cause severe damage at the time of accident occurred. Language: ko

Is Healing of Fractures Regulated Centrally?

The increased rate of fracture healing and abundant callus formation of long bone fractures in patients with concomitant severe acute traumatic head injury is a well-known orthopaedic phenomenon. Few studies, however, have reported this phenomenon being induced by acute traumatic Spinal Cord Injury (SCI). There is also a wellestablished clinical relationship between spinal cord injuries and heterotopic ossification. Research is yet to confirm accelerated bone healing in long bone fractures in patients with concomitant SCI and to establish theories about the mechanism causing it.

Pediatric bicycle-related head injuries: a population-based study in a county without a helmet law.

BackgroundHead injuries are the leading cause of death among cyclists, 85 % of which can be prevented by wearing a bicycle helmet. This study aims to estimate the incidence of pediatric bicycle-related injuries in Olmsted County and assess differences in injuries between those wearing helmets vs. not.MethodsOlmsted County, Minnesota residents 5 to 18 years of age with a diagnostic code consistent with an injury associated with the use of a bicycle between January 1, 2002, and December 31, 2011, were identified. Incidence rates were calculated and standardized to the age and sex distribution of the 2000 US white population. Type of injuries, the percentage requiring head CT or X-ray, and hospitalization were compared using a chi-square test. Pediatric intensive care unit (PICU) admission, permanent neurologic injury, seizure, need for mechanical ventilation, and mortality were compared using Fisher’s exact test.ResultsA total of 1189 bicycle injuries were identified. The overall age-adjusted incidence rate of all injuries was 278 (95 % CI, 249 to 306) per 100,000 person-years for females and 589 (95 % CI, 549 to 629) for males. The corresponding rates for head injuries were 104 (95 % CI, 87 to 121) for females and 255 (95 % CI, 229 to 281) for males. Of patients with head injuries, 17.4 % were documented to have been wearing a helmet, 44.8 % were documented as not wearing a helmet, and 37.8 % had no helmet use documentation. Patients with a head injury who were documented as not wearing a helmet were significantly more likely to undergo imaging of the head (32.1 percent vs. 11.5 %; p < 0.001) and to experience a brain injury (28.1 vs. 13.8 %; p = 0.008).ConclusionsChildren and adolescents continue to ride bicycles without wearing helmets, resulting in severe head and facial injuries and mortality.

Biomechanical Analysis Of Head And Neck Motions In Thrown Person By Judo Technique, Seoi-nage.

PURPOSE: Severe head and neck injuries have occasionally occurred in judo, an athletic event in the Olympic Games. Because the pattern and severity of these injuries strongly depend on the kinematic motion of the thrown person, it is indispensable to clarify biomechanically the mechanisms of head and neck injuries, in regard to various throwing techniques. The purpose of this study was to investigate the mechanical impact on head and neck when person was thrown by seoi-nage, one of the most popular skills. METHODS: Anthropomorphic test device (ATD), a model of the human body that is typically used in vehicle crash testing, was thrown by a male judo expert for 5 times using seoi-nage. A 3-axis accelerometer was mounted at the ATD head’s center of the gravity. Linear and angular accelerations of the head were measured by the accelerometers. Furthermore, we utilized 6-axis load cells to detect load and moment of the neck. To evaluate the impact on the neck, the neck injury criterion (Nij) was calculated. ATD kinematics data were also obtained using a high-speed digital video camera. RESULTS: When seoi-nage was performed, the dummy fell frontwards with the parietal area of the skull contacting the mat. Time courses for linear and angular accelerations were corresponded to the kinematics data of the ATD obtained by video camera. For linear head acceleration, peak resultant values ranged from 9.1 to 30.8 G (20.3±4.4 G, mean±S.E.). Angular peak resultant accelerations of the head ranged from 641.3 to 3195.4 rad/s2 (1890.1±515.1 rad/s2). These accelerations were considerably lower than those in our previous report where other throwing technique (e.g. osoto-gari) was examined (p<0.05, respectively). On the other hand, the Nij value was 1.03±0.19, implying that the impact on the neck by seoi-nage might exceed the neck injury threshold Nij 1. CONCLUSIONS: The acceleration shock of the head thrown by seoi-nage with the direct parietal region contact against the mat was smaller than those by other throwing skills. However, our results of Nij raised the possibility that the impact on the neck in thrown person by seoi-nage caused serious cervical damages.

Direct (presenting primarily to trauma center) versus indirect (referred or transferred) admission of patients to the Trauma Centre of King George Medical University: One-year prospective pilot study

Background:India does not have a trauma registry. There is lack of base line demographic data of trauma victims that present directly to the trauma center and those that are transferred to the trauma center.Aim:To compare the clinical and demographic profile of directly admitted (presenting primarily to the trauma center) and referred (transferred to trauma center) patients at the trauma centre of King George Medical University.Materials and Methods:The demographic and clinical profiles of patients admitted on thirty-three consecutive Mondays were collected and compared. In addition, the demographic data of patients admitted on Mondays and eight randomly selected Wednesdays and Saturdays were analyzed to ascertain the representativeness of the studied sample.Results:Of the 572 patients in the study, 327 were referred and 245 were directly admitted. There was 27% mortality in the referred group and 22% mortality in the directly admitted group, the difference been statistically insignificant (P value 0.20). Patients referred from peripheral hospitals were more severely injured with a lower GCS and a higher TRISS, and had a higher proportion of multi system major trauma and severe head injury.Conclusion:Referred admitted (transferred) patients at the KGMU trauma center are more seriously injured than the patients presenting directly. Yet there is no statistically significant difference in the overall mortality. A future study focusing on certain sub-categories of patients such as those demonstrating subdural hematoma, GCS less than 9 or ISS more than 15 may yield interesting data.

Falls and cerebellar ataxia

The paper considers the main causes of falls. Whatever their cause is, falls may lead to severe maladjustment in everyday life. In nearly 1 out of 10 cases, they are accompanied by severe injuries, including fractures (most commonly those of the proximal femur and humerus, hands, pelvic bones, and vertebrae), subdural hematoma, and severe soft tissue and head injuries. This process is emphasized to be multifactorial. Particular emphasis is laid on the involvement of the cerebellum and its associations, which may be accompanied by falls. This is clinically manifested mainly by gait disorders. Walking is a result of an interaction of three related functions (locomotion, maintenance of balance and adaptive reactions). In addition to synergies related to locomotion and balance maintenance, standing at rest and walking are influenced by the following factors: postural and environmental information (proprioceptive, vestibular, and visual), the capacity to interpret and integrate this information, the ability of the musculoskeletal system to make movements, and the capability to optimally modulate these movements in view of the specific situation and the ability to choose and adapt synergy in terms of external factors and the capacities and purposes of an individual. The clinical signs of damage to the cerebellum and its associations are considered in detail. These structures are emphasized to be involved not only in movements, but also in cognitive functions. The major symptoms that permit cerebellar dysfunction to be diagnosed are given. Symptoms in cerebellar injuries are generally most pronounced when suddenly changing the direction of movements or attempting to start walking immediately after a dramatic rise. The magnitude of ataxia also increases in a patient who tries to decrease the step size. Falling tendencies or bending to one side (in other symptoms characteristic of cerebellar diseases) suggest injury of the corresponding cerebellar hemisphere. Management tactics for patients for cerebellar disorders are considered.

Morphology of Acetabulum and Femoral Head-Neck Junction in Hip Dysplasia Which Underwent Rotational Acetabular Osteotomy

The purpose of this study was to evaluate the preoperative radiographs with cases of developmental dysplasia of the hip (DDH) leading to rotational acetabular osteotomy (RAO) or curved peri-acetabular osteotomy (CPO), and examine the frequency of femoroacetabular impingement (FAI) related bone morphology in the acetabulum and femoral head-neck junction. Twenty-four hips with hip dyaplasia who underwent CPO or RAO were included in this study. Six hips had grade 0 and eighteen hips had grade 1 OA according to the Tonnis classification. We excluded patients with moderate and severe hip osteoarthritis and major femoral head deformities. Preoperative radiograph was evaluated on sharp angle, center-edge angle, alpha angle, crossover sign and posterior wall sign. Crossover signs were revealed in 7 hips (29.2%); posterior wall signs were revealed in 16 hips (66.7%); and cam-type deformities with an alpha angle of ≥50.5˚ were observed in 19 hips (79.2%) in preoperative evaluation. As determined using the Tonnis scale, no progression of osteoarthritis was found in 16 of the 24 hips; there was a one-grade progression in 8 hips. Among the 8 hips, either positive cross-over sign or posterior sign in acetabulum, and an alpha angle of ≥50.5˚ in femur were observed in six hips with progression of osteoarthritis. The presence of cam-type deformity and acetabular retroversion in patients who underwent RAO or CPO was relatively high in preoperative radiographs, and caution should be employed during surgery in patients with DDH. There is a possibility of secondary FAI due to excessive forward coverage of the bone fragments after RAO and CPO.

A Real-Life Based Evaluation Method of Deployable Vulnerable Road User Protection Systems

Objective: The aim of this study was to develop a real-life-based evaluation method, incorporating vulnerable road user (VRU) full-body loading to a vehicle with a deployable protection system in relevant test setups, and use this method to evaluate a prototype pedestrian and cyclist protection system.Methods: Based on accident data from severe crashes, the most common scenarios were selected and developed into 5 test setups, 2 for pedestrians and 3 for bicyclists. The Polar II pedestrian anthropomorphic test device was used, either standing or on a standard bicycle. These test setups could then be used to evaluate real-life performance of a prototype protection system, regarding both positioning and protection, for vulnerable road users. The protection system consisted of an active hood and a windshield airbag and was mounted on a large passenger car with a conventional hood-type front end. Injury evaluation criteria were selected for head, neck, and chest loading derived from occupant frontal and side impact test methods.Results: The protection system managed to be fully deployed, obtaining the intended position in time—that is, before VRU body contact—in all test setups, and head protection potential was not negatively influenced by the preceding thoracic impact. Head loading resulted in head injury criterion (HIC) values ranging up to 4400 for the standard car, and all HIC values were below 650 with the protection system. The risk of severe (Abbreviated Injury Scale [AIS] 3+) head injury decreased from 85% to 100% in 3 test setups (mainly to the windscreen frame), to less than a 20% risk in all setups. In general, there were larger differences between structures impacted than between the pedestrian and cyclist setup. Neck loading was maintained at an acceptable level or was slightly decreased by the protection system, and chest loading was decreased from high values in 2 test setups in which the cyclist was impacted laterally with chest impact mainly to the hood area.Conclusions: A test method was developed to evaluate a more real-life-based test condition, as a complement to current component test methods. Being real-life based, including full-body loading, it is suggested as a complementary test method to the more simplified legal and rating component tests. Together these test methods will provide a more thorough evaluation of a protection system. The evaluated protection system performed well regarding both positioning and protection, indicating a capability to obtain the intended position in time with the potential to prevent the most common severe upper-body injuries of a pedestrian or cyclist in typical real-life accidents, without introducing negative side effects.

Geriatric High-Energy Polytrauma With Orthopedic Injuries: Clinical Predictors of Mortality.

Background:The impact of orthopedic injuries in the elderly patient with multi-trauma and the effect of operative fixation on these injuries have not been thoroughly evaluated.Methods:We reviewed geriatric patients (aged 65 and older) between 2004 and 2010 at a level 1 trauma center who sustained high-energy polytrauma (injury and severity score [ISS] ≥ 16) with associated orthopedic injuries. Patients were excluded if they had severe head and spine injuries, died on arrival, or had low-energy mechanisms of injury. Logistic regression was conducted to identify factors that predict mortality.Results:There were 154 patients who comprised our study group with an average age of 76 years and an ISS of 23. There were 96 males and 58 females. Overall, 52 patients died within 1 year of their admission: 21 patients during their initial hospital stay and 31 patients within 1 year following admission. In all, 64 (42%) patients underwent operative stabilization of their orthopedic injuries. Increased mortality was seen (P < .05) in female patients, those with lower admission Glasgow coma score, and those who underwent orthopedic surgery. Patients had worse outcomes if they sustained femur (P = .014), clavicle, or scapular fractures (P = .027). Other factures associated with higher mortality included pelvic/acetabular injury requiring surgery (P = .019) or spine fractures treated nonoperatively (P = .014).Conclusion:The effect of orthopedic injuries on this geriatric polytrauma group contribute to worse outcomes when they included clavicle, scapula, and femur fractures. We also found that pelvic/acetabular fractures treated operatively and nonoperative spine fractures were associated with higher mortality rates. Risk/benefit consideration is suggested when contemplating operative intervention in these patients.

Percutaneous Dilatational Tracheostomy - An Update

Percutaneous dilatational tracheostomy (PDT) is one of the most common procedures performed universally in patients admitted to medical and surgical intensive care units. Initially popularized in the 1980s, it can be performed by various techniques including Ciaglia’s blue Rhino, Griggs guide wire dilating forceps, Blue Dolphin, or the Perc Twist method. Bronchoscopy and ultrasound guidance have made these procedures much quicker and safer. Its main advantages over its centuries old counterpart, surgical tracheostomy (ST), include shorter procedure times, less perioperative bleeding, and a decreased risk of peristomal infection. PDT also appears to be more cost effective by preventing delays due to operating room scheduling issues and complications in transporting critically ill patients to the operating room for ST. Some patients, including those who are morbidly obese, those with prior tracheostomies, or patients with severe head and neck surgeries still remain good candidates for ST in general. Moreover, in experienced hands, PDT can also be performed. There are many physiological advantages of tracheostomy over the endotracheal tube such as reduction of airway resistance and anatomic dead space. Also, studies have shown decreased incidences of pneumonia, shorter inpatient stay length and reduced mortality with early tracheostomy. Nevertheless, the dilemma of appropriate timing to perform tracheostomy in the course of mechanical ventilation remains unanswered. Keywords: Complications, decannulation, percutaneous dilatational tracheostomy, techniques, timing, ultrasound guidance.

Disruption of G-Protein γ5 Subtype Causes Embryonic Lethality in Mice

Heterotrimeric G-proteins modulate many processes essential for embryonic development including cellular proliferation, migration, differentiation, and survival. Although most research has focused on identifying the roles of the various αsubtypes, there is growing recognition that similarly divergent βγ dimers also regulate these processes. In this paper, we show that targeted disruption of the mouse Gng5 gene encoding the γ5 subtype produces embryonic lethality associated with severe head and heart defects. Collectively, these results add to a growing body of data that identify critical roles for the γ subunits in directing the assembly of functionally distinct G-αβγ trimers that are responsible for regulating diverse biological processes. Specifically, the finding that loss of the G-γ5 subtype is associated with a reduced number of cardiac precursor cells not only provides a causal basis for the mouse phenotype but also raises the possibility that G-βγ5 dependent signaling contributes to the pathogenesis of human congenital heart problems.

Anatomy and clinical significance of the uncinate process and uncovertebral joint: A comprehensive review

The uncinate process and its associated uncovertebral articulation are features unique to the cervical spine. This review examines the morphology of these unique structures with particular emphasis on the regional anatomy, development and clinical significance. Five electronic databases were utilized in the literature search and additional relevant citations were retrieved from the references. A total of 74 citations were included for review. This literature review found that the uncinate processes and uncovertebral articulations are rudimentary at birth and develop and evolve with age. With degeneration they become clinically apparent with compression of related structures; most importantly affecting the spinal nerve root and vertebral artery. The articulations have also been found to precipitate torticollis when edematous and be acutely damaged in severe head and neck injuries. The uncinate processes are also important in providing stability and guiding the motion of the cervical spine. This review is intended to re-examine an often overlooked region of the cervical spine as not only an interesting anatomical feature but also a clinically relevant one.

Investigation on the cause and treatmene strategies for patients with severe acute head injury causes encephalocele

Objective To investigate the causes and treatment strategies of intraoperative encephalocele brain injury.Meethods 55 traumatic brain injury patients with intraoperative encephalocele were selected,the clinical data were retrospectively analyzed.Results 55 patients undergoing acute encephalocele reasons including widespread severity of brain contusion,acute brain swelling(19cases),delayed intracranial hematoma(28 cases),the late herniation,hematoma too long(4 cases),traumatic shock and hypotension leading to cerebral ischemia,hypoxia (4 cases).Assessed by GOS outcome at discharge:Good 3 cases,moderate disability in 5 cases,8 cases of severe disability,vegetative five cases,of whom 34 died.Conclusion Delayed intracranial hematoma,acutebrain swelling is an acute intraoperative encephalocele main reason.Clear intraoperative brain injury causes acute encephalocele,take appropriate measures as soon as possible,in order to achieve better results and reduce mortality. Key words: Meningocele ; Craniocrebral trauma; Intraoperative complications

Nonlinear effects from wave-induced maximum vertical bending moment on a flexible ultra-large containership model in severe head and oblique seas

Vertical bending moment (VBM) is of crucial importance in ensuring the survival of vessels in rough seas. With regard to conventional vessels, wave-induced maximum VBM is normally considered to be experienced in head seas. It is conservative to determine the extreme VBM based on either numerical simulations or model tests in long-crested head seas. Extensive model tests have been conducted in head seas with focus on the nonlinear vertical responses in severe seas, and the measured results were compared with numerical calculations for validation. Unexpected phenomena, however, were observed during the model tests of an ultra-large containership. The maximum sagging and hogging VBMs were encountered in oblique seas. Furthermore, the significant wave height used in oblique seas was even smaller than that used in head seas. The nonlinear vertical load effects in oblique seas require further investigations for this particular vessel. Limited experimental results in oblique seas have been reported, in which the lateral responses were always more concerned than the vertical responses. Up to now, rare systematic comparisons of the nonlinear vertical responses between head and oblique seas have been published, especially when the hydroelastic effects are also accounted for. A 13000-TEU ultra-large containership model, which was designed by Hyundai Heavy Industries (HHI), has been tested in the towing tank and the ocean basin at the Marintek center in Trondheim. The experimental results in regular waves are first compared between head and oblique seas. The statistical characteristics of the VBM amidships under nineteen irregular wave conditions are then investigated. Next, the extreme hogging and sagging VBMs are compared under different wave conditions with focus on the extreme hogging VBMs. At the end of the paper, the uncertainties in the experiments are discussed.

Parkour-Related Death: Case Report and Review of the Literature

Closely related to free running, parkour is a running sport that aims to traverse the environment as efficiently as possible, and may involve such stunt-like maneuvers as jumping over urban obstacles like benches, scaling walls, and even jumping from rooftops. We report a case of a young adult aficionado of parkour who suffered a fatal head injury from a short-distance fall while attempting a wall-hop and spinning maneuver in which he missed his grip on a railing. An autopsy was performed at the Medical Examiner's Office, with findings of blunt force trauma of the head. To our knowledge, this is the first case of parkour-related death reported in the medical literature, and we propose that this case may represent a prototype for the pattern of injury (i.e., severe blunt head trauma) that could prove fatal to a practitioner of parkour. Despite the seemingly apparent danger of these stunts, review of the medical literature reveals only a handful of reported cases of parkour-related injury. These injured parkour practitioners tend to be adolescent to young adult males, typically with fractures of the distal extremities (hands, feet, radii, and tibias) and clavicles. Finally, another forensically relevant feature of parkour-related death is the potential for difficulty in determining manner of death, distinguishing accident from suicide or even homicide, depending on the circumstances.

Do Parameters Used to Clear Noncritically Injured Polytrauma Patients for Extremity Surgery Predict Complications?

In multiply injured patients, definitive stabilization of major fractures is performed whenever feasible, depending on the clinical condition. We therefore asked whether (1) any preoperative indicators predict major complications after major extremity surgery; (2) perioperative routine parameters other than those indicative of hemorrhagic shock predict postoperative complications; and (3) any postoperative clinical findings can predict major complications in the further course of the patient. We prospectively followed patients with femoral midshaft fracture, Injury Severity Score (ISS) > 16 points, or three fractures and Abbreviated Injury Scale (AIS) ≥ 2 points and another injury (AIS ≥ 2 points), and age 18 to 65 years. We recorded multiple clinical parameters. End points were pneumonia, sepsis, acute respiratory distress syndrome, acute lung injury, and multiple organ failure. Forty-three of 165 patients developed complications. (1) Patients with complications had a decreased initial Glasgow Coma Scale and tended to have a lower ISS. (2) None of the assessed perioperative parameters was able to sufficiently predict postoperative complications. (3) The presence of a lung contusion and ventilation > 48 hours were associated with complications in the further course. In stable multiply injured patients, none of the individual routine clinical parameters was able to predict complications. Severe head and thoracic injuries seem to be important drivers for the development postoperative complications.

Interest of S100B protein blood level determination in severe or moderate head injury

S100B, a suffering brain marker, exhibits a different interest in traumatic brain injury (TBI) as the trauma is severe (sTBI) or mild (mTBI). Our works presented for the attribution of the SFBC 2012 price talked about both aspects. Firstly, the extent of S100B elevation has been found to be useful in predicting clinical outcome after sTBI. However, few studies were realized with jugular venous blood samples. After comparing the interest between jugular venous and arterial blood concentrations evaluation of serum S100B protein in patients with sTBI, determination of S100B concentration in jugular blood samples appears to be better than in arterial ones to predict clinical outcome after brain injury. Secondly, it's difficult to determine the indication of cranial computed tomography (CCT) for patients with mTBI. Actually, 90% of patients with mTBI have unnecessary CCT or short hospitalization for observation. Serum concentrations of S100B were found to provide useful information. We have investigated in 2 studies (1 for adult, 1 for children) whether S100B concentrations in patients with mTBI could provide additional information to improve indication of the need for an initial CCT scan or for a short hospitalization. Patients with intracerebral lesions on the CCT scan (CCT+) or with bad clinical evolution were identified with a sensitivity level of 100% and a specificity level of 30%. Adding the measurement of S-100B serum concentration to the clinical decision rules for a CCT scan or hospitalization in patients with mTBI could allow a 30% reduction in scans and in hospitalization for clinical observation.

The UK military experience of thoracic injury in the wars in Iraq and Afghanistan

IntroductionThoracic injury during warfare is associated with a high incidence of morbidity and mortality. This study examines the pattern and mortality of thoracic wounding in the counter-insurgency conflicts of Iraq and Afghanistan, and outlines the operative and decision making skills required by the modern military surgeon in the deployed hospital setting to manage these injuries. MethodsThe UK Joint Theatre Trauma Registry was searched between 2003 and 2011 to identify all patients who sustained battle-related thoracic injuries admitted to a UK Field Hospital (Role 3). All UK soldiers, coalition forces and local civilians were included. ResultsDuring the study period 7856 patients were admitted because of trauma, 826 (10.5%) of whom had thoracic injury. Thoracic injury-related mortality was 118/826 (14.3%). There were no differences in gender, age, coalition status and mechanism of injury between survivors and non-survivors. Survivors had a significantly higher GCS, Revised Trauma Score and systolic blood pressure on admission to a Role 3 facility. Multivariable regression analysis identified admission systolic blood pressure less than 90, severe head or abdominal injury and cardiac arrest as independent predictors of mortality. ConclusionsBlast is the main mechanism of thoracic wounding in the recent conflicts in Iraq and Afghanistan. Thoracic trauma in association with severe head or abdominal injuries are predictors of mortality, rather than thoracic injury alone. Deploying surgeons require training in thoracic surgery in order to be able to manage patients appropriately at Role 3.