Search

Objective: To examine agreement between parental reports of head injury and evidence of head injury in medical records and to compare these two measures in predicting early conduct disorder (CD). Design and Setting: Parent survey data was compared with records of child head injury from the National Health Services Register (Régie de l'assurance maladie du Québec, RAMQ) administrative database. Participants: Children (N = 685) ages 6–9 with and without CD. There were 147 children with RAMQ recorded head injury and 39 children with parent-reported head injury. Main Measures: Indication of one or more head injury before 6 years of age as reported by parents and/or as noted in medical data. Early CD (present by age 9) according to parents and/or teachers. Results: Results indicated poor agreement between the two forms of reporting κ =.161 (95% CI,.083 to.239), p < 0.001. Medical data significantly predicted the presence of CD in children, with a RAMQ coded head injury suggesting a child was 1.88 times more likely to have CD. Parent reports of head injuries did not significantly predict CD. Conclusion: Medical data should be prioritized in research addressing pediatric head injury, given that parent reports may fail to capture incidence of injury and therefore may be less predictive of other known correlates of head injury. [ABSTRACT FROM AUTHOR]

Repetitive subconcussive head impacts occur regularly in sports. However, the exact relationship between their biomechanical properties and their consequences on brain structure and function has not been clarified yet. We therefore reviewed prospective cohort studies that objectively reported the biomechanical characteristics of repetitive subconcussive head impacts and their impact on brain anatomy and function. Only studies with a pre- to post-measurement design were included. Twenty-four studies met the inclusion criteria. Structural white matter alterations, such as reduced fractional anisotropy and an increase in mean diffusivity values, seem to be evident in athletes exposed to repetitive subconcussive head impacts exceeding 10 g. Such changes are observable after only one season of play. Furthermore, a dose-response relationship exists between white matter abnormalities and the total number of subconcussive head impacts. However, functional changes after repetitive subconcussive head impacts remain inconclusive. We therefore conclude that repetitive subconcussive head impacts induce structural changes, but thus far without overt functional changes. [ABSTRACT FROM AUTHOR]

Background: Hypertrophic olivary degeneration (HOD) is a unique type of neuronal degeneration presenting as hypertrophy, in contrast to atrophy as seen in most cases. It presents with classical characteristic clinical features due to involvement of dentate-rubral-olivary pathway, also described as triangle of Guillain and Mollaret formed in midbrain, pons and cerebellum. It can be idiopathic or secondary to infarction, bleeding, tumours, trauma or demyelination. However, the mechanism is still unclear. Herein, we present a case of HOD that had developed after post-traumatic pontine and midbrain haemorrhagic contusion. Case presentation: A young male patient presented with progressively increasing tremors of both hands, inability to walk and multiple cranial nerve palsy. Magnetic resonance imaging demonstrated bilateral inferior olivary nucleus enlargement and signal changes seen as T2 and T2-FLAIR hyperintensities and non-enhancing T1 iso-intensities. Based on these features, diagnosis of HOD was made. Patient was kept on conservative management and his condition improved. Conclusions: Hypertrophic olivary degeneration is a unique neuronal degeneration with typical clinical manifestations and distinct imaging features. Proper and early recognition and multidisciplinary treatment approach can result in the best outcomes for the patient. [ABSTRACT FROM AUTHOR]

BACKGROUND: Over 5% of the global population (430 million people) require rehabilitation for hearing loss. Individuals with hearing impairments face significant challenges in business, daily life, and social participation. Hearing loss (HL) and other permanent physical and sensory disabilities escalate dramatically in cases with brain damage and temporal bone trauma associated with head injuries. This study aims to identify the significant risk factors for hearing loss following head trauma, utilizing current data, and discuss the findings in the context of the literature. This could contribute to the development of standard approaches for assessing such cases. METHODS: This retrospective study reviewed files and reports from individuals assessed for hearing loss at Dokuz Eylül University Faculty of Medicine, Department of Forensic Medicine. The study included cases that applied at least 12 months post-trauma, between January 1, 2016, and December 31, 2022, after their recovery process was completed. Sociodemographic data, types of temporal bone fractures, initial otoscopic examination findings, presence or absence of intracranial injury, type of hearing loss, and audiometry test results for air and bone conduction pure tone threshold averages were evaluated. Data analysis was conducted using SPSS 26.0 (Statistical Package for the Social Sciences). RESULTS: Out of 244 cases, 177 (72.5%) were male and 67 (27.5%) were female. It was observed that the majority of trauma cases occurred in the 19-40 age group (49.2%; n=120). In the initial otoscopic examinations post-trauma, otorrhagia/otorrhea was the most common finding, both as an isolated symptom (n=59, 24.2%) and when accompanied by other symptoms. No temporal bone fractures were detected in 43 cases (17.6%). Longitudinal fractures were found in 141 cases (57.8%), transverse fractures in 48 (19.7%), and mixed-type fractures in 12 (4.9%). The statistical difference in air conduction and bone conduction pure tone threshold averages between groups with and without intracranial injury was significant (p<0.001). CONCLUSION: Post-traumatic examinations should employ a multidisciplinary approach, adhering to standard medical improvement and assessment timelines. It is essential to verify whether each patient's medical improvement process has reached its maximum potential. We believe that adhering to these recommendations and utilizing standardized classifications for hearing loss will prevent the loss of rights. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to provide an overview of dizziness post head injury in those with prominent features for central vestibular dysfunction (CVD) in comparison to those with a post-traumatic peripheral vestibular etiology. Study design: Retrospective. Setting: University Health Network (UHN) Workplace Safety and Insurance Board (WSIB) database from 1988 to 2018 were evaluated for post-traumatic dizziness. Methods: The UHN WSIB neurotology database (n = 4291) between 1998 and 2018 was retrospectively studied for head-injured workers presenting with features for CVD associated with trauma. All patients had a detailed neurotological history and examination, audiovestibular testing that included video nystagmography (VNG) and cervical vestibular-evoked myogenic potentials (cVEMPs). Imaging studies including routine brain and high-resolution temporal bone computed tomography (CT) scans and/or intracranial magnetic resonance imaging (MRI) were available for the majority of injured workers. Results: Among 4291 head-injured workers with dizziness, 23 were diagnosed with features/findings denoting CVD. Complaints of imbalance were significantly more common in those with CVD compared to vertigo and headache in those with peripheral vestibular dysfunction. Atypical positional nystagmus, oculomotor abnormalities and facial paralysis were more common in those with CVD. Conclusion: Symptomatic post-traumatic central vestibular injury is uncommon. It occurred primarily following high-impact trauma and was reflective for a more severe head injury where shearing effects on the brain often resulted in diffuse axonal injury. Complaints of persistent imbalance and ataxia were more common than complaints of vertigo. Eye movement abnormalities were highly indicative for central nervous system injury even in those with minimal change on CT/MRI. [ABSTRACT FROM AUTHOR]

Background & Objective: Headache is a common complaint among traumatic patients referring to the emergency department. To improve headache in these patients, an effective, fast-acting, accessible and inexpensive drug without a significant effect on the level of consciousness and vital signs is highly needed. Materials & Methods: In this double-blind randomized clinical trial (RCT) on patients with head trauma, Group A was given 5% intranasal lidocaine spray while group B was prescribed 10% intranasal lidocaine spray to improve headache. Headache severity was checked based on numeric pain scale (NPS) before drug administration and then at 5, 15, 30 minutes and plus 1 hour post-drug administration, along with patient satisfaction and possible side effects. Finally, the obtained data were analyzed using SPSS 23 software. Results: According to the data, the maximum reduction in headache occurred 5 minutes after the drug administration. There was a significant difference between the two groups in terms of satisfaction (P value = 0.022), where group A had 100% high satisfaction while group B had 87.5% high satisfaction and 12.5% had moderate satisfaction. Of the 80 patients in the study, 3 patients had tearing complications after medication administration, which resolved after 5 minutes, and one case had nasal mucosal anesthesia, which improved after 15 minutes. Conclusion: According to the results of this study, the use of 5% intranasal lidocaine spray is as effective as 10% intranasal lidocaine spray in relieving headache in traumatic patients and was associated with greater satisfaction and fewer complications. [ABSTRACT FROM AUTHOR]

Copyright of Bosphorus Medical Journal / Boğaziçi Tıp Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abusive head trauma (AHT) is an extreme form of physical child abuse, a subset of which is shaken baby syndrome (SBS). While traumatic injury in children is most readily observed as marks of contusion on the body, AHT/SBS may result in internal injuries that can put the life of the child in danger. One pivotal sign associated with AHT/SBS that cannot be spotted with the naked eye is retinal injury (RI), an early sign of which is retinal hemorrhage (RH) in cases with rupture of the retinal vasculature. If not addressed, RI can lead to irreversible outcomes, such as visual loss. It is widely assumed that the major cause of RI is acceleration–deceleration forces that are repeatedly imposed on the patient during abusive shaking. Still, due to the controversial nature of this type of injury, few investigations have ever sought to delve into its biomechanical and/or biochemical features using realistic models. As such, our knowledge regarding AHT-/SBS-induced RI is significantly lacking. In this mini-review, we aim to provide an up-to-date account of the traumatology of AHT-/SBS-induced RI, as well as its biomechanical and biochemical features, while focusing on some of the experimental models that have been developed in recent years for studying retinal hemorrhage in the context of AHT/SBS. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the hypothesis that identical abbreviated injury scale (AIS) scores may lead to varying risks of in-hospital mortality and admission to the intensive care unit (ICU) depending on the specific body region affected. Methods: This study focused on hospitalized trauma patients with moderate to serious injuries (AIS=2, 3). The final sample was stratified based on the injured body regions. To determine the impact of these injuries on mortality and ICU admission, we conducted binary logistic regression after adjusting for confounding factors. Results: Overall, 16,040 trauma patients with moderate injury (AIS=2) and 1,338 trauma patients with serious injury (AIS=3) were included in this study. When comparing outcomes of trauma patients in different body regions, there was no significant difference in the odds of two main outcomes in various injury sites, except for extremities (P values>0.05). When the AIS=2 patients were controlled for confounding factors, the adjusted odds of mortality were significantly higher for head, face, and neck injuries, as well as spine/back, thoracic, and abdominal injuries, compared to extremity injuries (adjusted odds ratio (aOR)s=9.81, 8.78, 8.11, and 3.96, respectively; P-values<0.05). Among those with AIS=3, the odds of mortality were significantly greater for abdominal (aOR=7.05, P-value=0.009) and head, face, and neck injuries (aOR=2.73, P-value=0.001) than for extremity injuries. Conclusion: Injuries with the same AIS (=2, 3) value almost indistinguishably confer the same mortality risk and ICU admission, except for extremities. The unique AIS value assigned to various body sites almost consistently indicates the same likelihood of negative outcomes. [ABSTRACT FROM AUTHOR]

Childhood head injuries and conduct problems increase the risk of aggression and criminality and are well-known correlates. However, the direction and timing of their association and the role of their demographic risk factors remain unclear. This study investigates the bidirectional links between both from 3 to 17 years while revealing common and unique demographic risks. A total of 8,603 participants (50.2% female; 83% White ethnicity) from the Millennium Cohort Study were analysed at 6 timepoints from age 3 to 17. Conduct problems were parent-reported for ages 3 to 17 using the Strengths and Difficulties Questionnaire (SDQ) and head injuries at ages 3 to 14. A cross-lagged path model estimated the longitudinal bidirectional effects between the two whilst salient demographic risks were modelled cumulatively at three ecological levels (child, mother, and household). Conduct problems at age 5 promoted head injuries between 5 and 7 (Z = 0.07; SE = 0.03; 95% CI, 0.02–0.13), and head injuries at ages 7 to 11 promoted conduct problems at age 14 (ß =.0.06; SE =.0.03; 95% CI, 0.01–0.12). Head injuries were associated with direct child-level risk at age 3, whereas conduct problems were associated with direct risks from all ecological levels until 17 years. The findings suggest a sensitive period at 5–11 years for the bidirectional relationship shared between head injuries and conduct problems. They suggest that demographic risks for increased head injuries play an earlier role than they do for conduct problems. Both findings have implications for intervention timing. [ABSTRACT FROM AUTHOR]

Background: In the U.S., there are approximately 1,300 abusive head trauma (AHT) cases reported annually, with 25% of them fatal. Objective: This is a descriptive study of child maltreatment (CM)-related homicides resulting from AHT. Methods: Data from the National Violent Death Reporting System (NVDRS) for 2012–2017 were used to describe child homicide cases resulting from AHT of children aged 0–17 years. Results: During 2012–2017, among the 1,957 deaths from CM-related homicides, 230 resulted from AHT. More than half of the victims of AHT were male children, and greater than half of the AHT-related deaths were perpetrated by males, with fathers as the perpetrator in 43% of the cases. In addition, more than one-third of AHT victims (44%), as well as perpetrators (36%), were White, non-Hispanic. Almost half of AHT victims had a previous history of abuse, 37% had a nonfatal injury prior to their death, and 22% of their deaths were precipitated by child's crying behavior. Conclusion: This paper describes the prevalence of AHT deaths from 2012 to 2017 data, along with multiple risk factors that are associated with victim death AHT and perpetration of this type of maltreatment. These findings can inform targeted prevention strategies for the most extreme forms of AHT, those that result in child death. [ABSTRACT FROM AUTHOR]

Background: Road traffic injuries are India's sixth leading cause of death, affecting youth and middle-aged individuals. Rapid motorized traffic growth, particularly two-wheelers (72% of vehicles), has increased accidents. Inadequate and non-uniform helmet regulations worsen the situation. Road injuries strain healthcare, demanding hospitalization, and rehabilitation. Kerala experiences significant two-wheeler accidents, often fatal due to head injuries. Studying injury patterns and causes among riders in fatal accidents is vital. Methods: A cross-sectional study was conducted at Govt TD Medical College, Vandanam, Kerala, following approval from the Institutional Ethics Committee. The study included all deaths of two-wheeler riders involved in road traffic accidents with clear vehicle information, excluding decomposed or unidentified bodies. A total of 101 cases were analyzed, recording external and internal injuries directly onto the Proforma during autopsy. Data were summarized using frequencies and proportions, while the chi-square test assessed relationships between categorical variables. Conclusion:The study found that most accidents occurred between 6-9 pm, involving mainly male (91.1%) two-wheeler riders (80.8%). Few wore helmets (5%). Head injuries (97%) were common, often caused by ejection from vehicles (87%). Non-helmet use and ejection related significantly to head injuries, a leading cause of twowheeler accident fatalities. [ABSTRACT FROM AUTHOR]

Purpose: Injuries constitute a leading and growing cause of emergency department (ED) visits in sub-Saharan Africa. Characteristics of ED injury patients have been well-described in many parts of the world; however, data remain scarce throughout Africa, Botswana included. We aimed to describe in detail injury-related ED visits at an urban public referral hospital in Botswana. Methodology: We conducted a retrospective chart review of all patients who presented to Princess Marina Hospital in Gaborone, Botswana, over a period of 4 randomly selected consecutive months. Demographic data, injury mechanism, type, severity and ED disposition were abstracted from the medical record into a Microsoft Access database designed for this study. Study variables were analyzed with summary statistics for frequencies, percentages, means, medians and relationships using SPSS. Injury severity was calculated for each patient using the modified Kampala Trauma Score. Results: 6715 ED visits occurred during the study period, and 1709 (25.5%) were injury related. Of these, 63.9% were male, 24.7% <14 years old, 6.7% age 14-19, 49.1% 20-40, and 19.5% >40. 35.9% were due to falls, 23.6% assault and 18.8% road traffic crashes. 40.5% isolated soft tissue injuries, 34.7% isolated extremity injuries, 9.4% multiple injuries and 5.3% head and neck injuries. Kampala Trauma Score II (KTS) was available for 76% of patients. 1.7% scored =6, 5.9% 7-8, and 92.4% 9-10. For patients with KTS =6, 18% died in the ED, 82% were admitted and 0% discharged home. For KTS 7-8, 0% died, 93.5% were admitted, 6.5% were discharged home. For KTS II 9-10, 0% died, 26% were admitted, 74% were discharged home. Unique Contribution to Theory, Practice and Policy: This study is among the first in Botswana to assess the burden of injuries using a validated injury severity scoring tool. Based on the study findings and applicability of the KTS II in our setting, we recommend that PMH ED incorporates and promotes a severity scoring system to help in planning and resource allocation. PMH ED receives many low acuity injuries therefore improving the availability of basic resources in local clinics may reduce overcrowding. Future studies should aim to involve multiple centers to get a true representation of injury burden in Botswana. [ABSTRACT FROM AUTHOR]

The article focuses on a novel study investigating the relationship between repetitive head impacts (RHIs) and chronic traumatic encephalopathy (CTE) in young contact sport athletes, revealing significant CTE pathology in a substantial percentage of cases. Topics include the demographic characteristics of athletes with CTE, the association between years of sports participation and CTE prevalence, and the absence of notable differences in clinical measures between athletes with and without CTE.

Background: Despite the use of care bundles, ventilator associated pneumonia (VAP) remains a frequently occurring health care-associated infection, increasing costs, length of stay (LOS) and mortality. The incidence is higher amongst trauma patients, although due to variable definitions and study populations risk factors for developing VAP are disputed, with few reports from the UK. Methods: This 6-year review of intubated trauma patients admitted to the general Intensive Care Unit (ICU) of a UK major trauma centre, collected data on suspected risk factors for VAP, as well as demographic information, outcomes and microbiology. Ninety-nine patients who developed VAP within the first 7 days of admission were compared with 191 patient who did not, with multivariable logistic regression used to control for confounding variables. Results: Univariable analysis suggested that injury severity score (ISS) (34 v 29), head injury (66.7% v 50.8%), polytrauma (79.8% v 68.1%) and ventilator days (10 v 5) were associated with increased risk of VAP, but after adjustment only ventilator days remained significant (OR 1.04, 95% CI 1.01–1.06). Antibiotics within 24 h of admission were associated with reduced odds of developing VAP, whether this was for pulmonary prophylaxis (OR 0.43, 95% CI 0.22–0.83, p = 0.013) or non-pulmonary reasons (OR 0.27, 95% CI 0.15–0.51, p < 0.001). Conclusions: Only increasing ventilator days was associated with increased odds of developing VAP. The use of early antimicrobials was associated strongly with a reduction in the odds of developing VAP; this could be explained by unmeasured confounding or a prophylactic effect against aspiration. [ABSTRACT FROM AUTHOR]

The article examines the link between repeated head trauma in contact sports and parkinsonism in chronic traumatic encephalopathy (CTE), focusing on tau-related neurofibrillary tangles, neuronal loss, and non-synuclein pathology.

The article focuses on the connection between head impacts and the development of chronic traumatic encephalopathy (CTE) in male athletes, highlighting that the cumulative number and severity of head impacts throughout an athlete's life are better predictors of CTE than the number of symptomatic concussions. Topics include the pathophysiology of CTE, the study's methodology in assessing repetitive head impacts, and the importance of understanding the role of repetitive hits in CTE development.

Background: Mixed martial arts (MMA) fighters, due to exposure to repetitive head impacts, are at risk for brain atrophy and neurodegenerative sequelae. Simultaneously, motor skills training and cognition-rich activities have been linked with larger regional brain volumes. The majority of an MMA fighter's sporting activity occurs during practice (e.g., sparring) rather than formal competition. This study, therefore, aims to be the first to explore regional brain volumes associated with sparring in MMA fighters. Methods: Ninety-four active, professional MMA fighters from the Professional Fighters Brain Health Study met inclusion criteria for this cross-sectional analysis. Adjusted multivariable regression analyses were utilized to examine the relationship between the number of sparring practice rounds per week during typical training and a select number of regional brain volumes (i.e., caudate, thalamus, putamen, hippocampus, amygdala). Results: A higher number of weekly sparring rounds during training was significantly associated with larger left (beta = 13.5 µL/round, 95% CI 2.26–24.8) and right (beta = 14.9 µL/round, 95% CI 3.64–26.2) caudate volumes. Sparring was not significantly associated with left or right thalamus, putamen, hippocampus, or amygdala volumes. Conclusions: More weekly rounds of sparring was not significantly associated with smaller volumes in any of the brain regions studied in active, professional MMA fighters. Sparring's significant association with larger caudate volume raises questions about whether fighters who spar more experience attenuated trauma-related decreases in caudate volume relative to fighters who spar less, whether fighters who spar more experience minimal or even positive changes to caudate volume, whether baseline differences in caudate size may have mediated results, or whether some other mechanism may be at play. Given limitations inherent to the cross-sectional study design, more research is needed to further explore the brain effects of sparring in MMA. [ABSTRACT FROM AUTHOR]

Objective: Concussion is a common ED complaint, but diagnosis is challenging as there are no validated objective measures. Use of concussion tools derived from sports medicine is common, but these tools are not well validated in ED settings. The aim of this study was to assess the ability of the Sport Concussion Assessment Tool 5th Edition (SCAT5) to identify concussion in ED patients presenting following head injury. Methods: We conducted a prospective observational study of head‐injured adult patients presenting to ED between March and July 2021. ED diagnosis of concussion was used as the diagnostic standard, and we assessed the diagnostic performance of the SCAT5 test and its three subsections (Standardised Assessment of Concussion (SAC), Post‐Concussion Symptom Scale (PCSS) and Modified Balance Error Scoring System (mBESS)) against this. Results: Thirty‐two head‐injured participants were enrolled, 19 of whom had a discharge diagnosis of concussion, alongside 17 controls. Median time for SCAT5 testing was 21 (interquartile range 16–27) min. Fifteen (30.6%) participants were interrupted during testing. Area under the curve (AUC) (95% confidence interval) for the SAC, PCSS and mBESS were 0.51 (0.34–0.68), 0.92 (0.84–0.99) and 0.66 (0.47–0.85), respectively. Sensitivity and specificity of sections were as follows: entire SCAT5 (100.0%, 20.0%), SAC (48.1%, 60.0%), PCSS (89.7%, 85.0%) and mBESS (83.3%, 58.8%). Using PCSS alone would have identified 17 of 19 concussions. Conclusion: The SCAT5 test had a low specificity, was long and was frequently interrupted. We suggest it is not an ideal assessment to use in ED. The PCSS score performed well and was easy to complete. It may be useful as a standalone tool to simplify ED concussion identification. [ABSTRACT FROM AUTHOR]

The article focuses on the first successful plea of insanity defense in history, specifically the case of James Hadfield. Topics include the impact of social influences on psychiatry, the historical significance of the trial, and the arguments made by Thomas Erskine regarding insanity and criminal responsibility.

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Minor head trauma (MHT) is very frequent in children and post-traumatic headache (PTH) is one of its most common complications; however, its management is still a challenge. We aimed to assess the incidence and clinical characteristics of, and risk factors for, PTH among children referred to our pediatric emergency department (PED) for MHT. A total of 193 patients aged 3–14 years evaluated for MTH were enrolled and followed up for 6 months through phone calls and/or visits. PTH occurred in 25/193 patients (13%). PTH prevalence was significantly higher in school-aged (≥6 years) than in pre-school-aged children (21.6% vs. 4.9%, respectively, p < 0.009). Females were found to be more affected. The median time of onset was 4.6 days after MHT; resolution occurred in a median of 7 weeks. In 83.3% of patients, PTH subsided in <3 months, while in 16.7% it persisted longer. A total of 25% of children exhibited the migraine and 75% the tension-type variant. Our analysis indicates the presence of headache upon arrival in PED, isolated or associated with nausea and dizziness, as a factor predisposing the patient to the development of PTH. Our findings could be useful to identify children at risk for PTH for specific follow-up, family counseling, and treatment. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Approximately 30% of patients meeting severe injury criteria are never transferred to lead trauma centers (LTCs). The reasons for this gap are not fully understood but involve both system-level factors and individual decision-making. We used a method called discrete choice modeling (DCM) to evaluate which clinical and demographic patient factors might make emergency physicians more likely to initiate transfers to LTCs. Methods: An email survey was distributed to physicians working in emergency departments (EDs) in Ontario. The relative importance of clinical and demographic patient attributes as drivers for transfer was evaluated using DCM. Simulated patient cases were created using a random generator to combine attributes. Each respondent was presented with 36 different patients in sets of three and asked if they would transfer each patient to an LTC. The relative importance of each driver was then compared across physician characteristics. Results: One hundred and fifty three emergency physicians completed the survey. The drivers for transfer, expressed as utility scores, were derangements in hemodynamics (22), CNS/head injuries (19), pelvic fractures (11), chest injuries (10), comorbidities (9), abdominal injuries (8), extremity injuries (7), mechanism of injury (7), age (5), and gender (2). Drivers for patient transfer did not differ based on physician experience or type of training. Conclusion: In this DCM study, the clinical and demographic factors most likely to make emergency physicians consider patient transfers to LTCs were patient hemodynamic derangements and CNS/head injuries. Overall, these drivers did not differ by physician experience or training. An understanding of such patient-level drivers for transfers to LTCs may improve the implementation of evidence-based interfacility transfer criteria. [ABSTRACT FROM AUTHOR]

Head injury is the most common cause of death and disability in people aged one to 40 in the UK, and accounts for around 1.4 million attendances at emergency departments (EDs) in England and Wales each year. [ABSTRACT FROM AUTHOR]

Suprasegmental features are often affected by brain damage, and are typically accompanied by motor speech disorders such as dysarthria, apraxia of speech (AOS), and foreign accent syndrome (FAS). However, there is no report of a selective pitch accent disorder without motor speech impairments or FAS. We describe a female Japanese patient who developed a selective pitch accent disorder without motor speech impairments or FAS, with accompanying mild Wernicke's aphasia due to head injury, in order to investigate the mechanism of pitch accent disorder based on speech production models. We analysed her spontaneous speech, confrontation naming, repetition, reading aloud, and the error patterns in her pitch accents in two sessions. Additionally, we gave her a reading aloud test of homonyms with different accent patterns and an auditory discrimination task of pitch accents. The patient exhibited a significant recovery from aphasia, and paraphasia was observed to almost disappear, although the pitch accent errors remained in all speech modalities. While she was able to auditorily distinguish between correct and incorrect pitch accents, she was unaware of her own abnormally accented speech. The results of the analysis of the error patterns in her pitch accents revealed that they, even if incorrect for the selected words, did not actually deviate from the correct patterns in the Osaka dialect, her native dialect. Our observations suggest that the process of pitch accent production may be independent of that of phoneme production. Moreover, it may be that her accent abnormalities were not produced randomly during the process of articulation, but instead may have been due to a problem in selecting pitch accent patterns from the repertoire of Osaka accent patterns allocated to the corresponding words. This suggests that the patient's pitch accent disorder was a problem in a higher level of linguistic processing, i.e., lexical pitch accent encoding, rather than the motor control of speech production. [ABSTRACT FROM AUTHOR]

Background and Aim The most concern in children with head and facial trauma is the effects of the trauma and the treatment on their growth considering the possibility that the teeth with different stages of evolution in the fracture line have different prognosis in growth and deformity. The present study aims to examine the status of the teeth in the fracture lines of children in order to check the effects of head and facial trauma on these teeth. Methods & Materials Participants were 28 children under 12 years of age with jaw fracture admitted to the maxillofacial surgery department of Bahonar Hospital, Kerman, Iran from 2010 to 2016. Their information was extracted from their medical files and the teeth in the fracture line were clinically evaluated. Panoramic graphs were taken immediately after and 6 to 24 months after the surgery. The information examined in the panoramic graphs included the internal and external erosion, pathological lesion, and eruption rate of the teeth in the fracture line. Ethical Considerations This article was approved by the ethics committee of Kerman University of Medical Sciences (Ethical Code: IR.KMU.REC.1396.1398). Results It was found that 60.7% of the fractures occurred in the lower jaw, of which 67.9% were treated by closed reduction method and 10.7% by open reduction method. Moreover, 89.3% of the teeth had no pathological lesion. In 78.6% and 71.4% of cases, no dental discoloration and necrosis were observed, respectively. Moreover, 82.1% of the teeth had reached full eruption. Conclusion Most of the teeth in the fracture line reaches full eruption with no pathological lesion, discoloration, root deformity, and looseness, and there is no difference in this respect between patients received open and closed reduction methods. [ABSTRACT FROM AUTHOR]

This study estimates the prevalence and risk factors of accidents and injuries among iron and steel industry workers. A cross-sectional study (N = 505) was conducted from November 2019 to March 2020 in the Indian Iron and Steel Company (IISCO), Burnpur, West Bengal, India. The result shows that about 28% of workers experienced accidents and injuries in the last 12 months. The most frequent injuries reported were cuts from sharp objects (37.32%), followed by fractures and dislocation (30.28%) and burns (19.01%), upper head injury (23.24%) and arm/shoulder injury (14.08%). Non-technical education (adjusted odds ratio [AOR]: 2.52), higher exposure in risky and polluted areas (AOR: 2.85), alcohol consumption (AOR: 2.47), poor occupational health and safety knowledge (AOR: 0.65) were significantly associated with work-related injuries. Occupational health and safety knowledge and usage of safety measures must be propagated and monitored to curb accidents and injuries among iron and steel industry workers in India. [ABSTRACT FROM AUTHOR]

This study sought to describe head impact exposure in women's collegiate club lacrosse. Eleven women's collegiate club lacrosse players wore head impact sensors during eight intercollegiate competitions. Video recordings of competitions were used to verify impact data. Athletes completed questionnaires detailing their concussion history and perceived head impact exposure. During the monitored games, no diagnosed concussions were sustained. Three athletes reported sustaining head impacts (median = 0; range: 0–3 impacts per game). Six impacts registered by the sensors were verified on video across a total of 81 athlete-game exposures. Verified impacts had a median peak linear acceleration of 21.0 g (range: 18.3 g – 48.3 g) and peak rotational acceleration of 1.1 krad/s2 (range: 0.7 krad/s2 – 5.7 krad/s2). Women competing in collegiate club lacrosse are at a low risk of sustaining head impacts, comparable to previous reports of the high school and collegiate varsity levels of play. [ABSTRACT FROM AUTHOR]

Abusive head trauma (AHT) can result in retinal complications that require operative intervention. There is no review evaluating the outcomes of vitreoretinal operations in aggregate or on the timing of vitreoretinal intervention. This systematic review aims to fill this knowledge gap. A literature search between 2011 and 2021 was performed with PubMed, Web of Science, and Embase. Included articles described outcomes of vitreoretinal operations after AHT either in aggregate or as individual cases. Nine articles met criteria; the direct outcomes of operations were collected to minimize bias. Visual acuity (VA) and anatomic outcomes were compared between patients who received operations within 4 weeks of diagnosis and those who had delayed intervention. This review found that vitreoretinal surgery after AHT has excellent anatomical success rates, but there is a trend toward improved VA outcomes when performed within 4 weeks of diagnosis. This highlights the importance of urgent referral to a pediatric retina surgeon for non-clearing vitreous hemorrhage, retinal detachment, and retinal tears after AHT. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic epidural hematoma (EDH) accounts for 1-3% of pediatric closed head injury admissions. There is a 2.5:1 male predominance. Etiology varies by age; motor vehicle collisions are the primary cause of EDH in adolescents. Post-traumatic EDH accompanies up to 4% of adult head injuries, and is associated with 10% mortality in adults and 5% mortality in children. In North America, standard of care for post-traumatic EDH includes decompressive craniotomy or trepanation via burr hole. Such lifesaving care is typically provided in the operating room by consulting neurosurgery teams or other personnel trained in the use of burr hole equipment.Case Report: The case of a 17-year-old female patient who presented to a community emergency department (ED) after being involved in a motor vehicle collision is discussed. At the scene of the accident, she refused emergency medical services transport and was brought to the ED via private vehicle. She quickly decompensated in the ED and required intubation. Neurosurgical services were not available and transport to the nearest pediatric trauma center was delayed due to weather. Decompression and drainage of her EDH was accomplished with an EZ-IO® driver and intraosseous needle under virtual guidance of a pediatric neurosurgeon until definitive care could be obtained. The patient made a full neurologic recovery.Why Should An Emergency Physician Be Aware Of This: EDHs have high morbidity and mortality. In settings without access to neurosurgical services, and where ED access to or familiarity with burr hole equipment is limited, the EZ-IO® device may be a temporizing and lifesaving intervention until definitive neurosurgical care can be obtained. [ABSTRACT FROM AUTHOR]

Determine if head-injury exposure relates to later-in-life cognitive decline in older National Football League (NFL) retirees. NFL retirees (aged 50+) with or without cognitive impairment underwent baseline (n = 53) and follow-up (n = 29; 13–59 months later) neuropsychological evaluations. Cognitively normal (CN) retirees (n = 26) were age- and education-matched to healthy controls (n = 26). Cognitively impaired (CI) retirees with mild cognitive impairment or dementia (n = 27) were matched to a clinical sample (CS) by age, sex, education, and diagnosis (n = 83). ANOVAs compared neuropsychological composites at baseline and over time between retirees and their matched groups. Regression models evaluated whether concussions, concussions with loss of consciousness (LOC), or games played predicted neuropsychological functioning. At baseline, CN retirees had slightly worse memory than controls (MCN retirees = 50.69, SECN retirees = 1.320; MHealthy controls = 57.08, SEHealthy controls = 1.345; p = 0.005). No other group diferences were observed, and head-injury exposure did not predict neurocognitive performance at baseline or over time. Head-injury exposure was not associated with later-in-life cognition, regardless of cognitive diagnosis. Some retirees may exhibit lower memory scores compared to age-matched peers, though this is of unclear clinical significance. [ABSTRACT FROM AUTHOR]

Introduction: Injury caused by large animals varies according to the regional distribution of the animals and their relationship to humans. Camels are usually friendly to humans; however, occasionally they become very hostile, especially in rutting season. Most in-hospital trauma deaths are related to head injury. Very few studies in the literature have discussed camel-related head injuries. We aimed to study the incidence, mechanism of injury, types, and outcome of camel-related head injury in a high-income developing country to give recommendations on preventive measures. Methods: We retrospectively collected data from all patients who were admitted to Al Ain Hospital with a camel-related head injury from January 1, 2015, to January 1, 2021. Data collected included demography, mechanism of injury, anatomical location, severity of the injury, associated injuries, and management. The patients were followed up during their hospital stay to record the length of hospital stay, complications, and outcome. Results: During the study period, 98 patients were admitted to Al Ain Hospital with camel-related injury. Thirty-nine (39.8%) of the admitted patients with a camel-related injury sustained a head injury; a camel-related head injury was more common during August (23.1%). Thirty-four (87.2%) patients were camel caregivers. Thirty-three patients (84.6%) were injured on farms. Seven patients suffered an intracranial hemorrhage, and six (85.7%) of them had a history of fall from a camel. Glasgow Coma Score was significantly correlated to the severity of head injury measured by Abbreviated Injury Severity of the head (P = 0.006, Spearman's correlation). One patient died during the study period after having decompressive craniectomy for subdural hemorrhage (overall mortality 2.6%). Conclusions: The majority of camel-related head injury occurred in camel caregivers at camel farms and can be considered a work-related injury. Careful handling of camels, especially during the summertime can reduce the toll of camel-related head injury and its serious consequences. None of the injured patients was wearing a helmet at the time of injury. Legislation for compulsory helmet usage by camel caregivers at farms may decrease the incidence of head injuries in those patients. [ABSTRACT FROM AUTHOR]

Objective: To update the existing CHIP (CT in Head Injury Patients) decision rule for detection of (intra)cranial findings in adult patients following minor head injury (MHI).Methods: The study is a prospective multicenter cohort study in the Netherlands. Consecutive MHI patients of 16 years and older were included. Primary outcome was any (intra)cranial traumatic finding on computed tomography (CT). Secondary outcomes were any potential neurosurgical lesion and neurosurgical intervention. The CHIP model was validated and subsequently updated and revised. Diagnostic performance was assessed by calculating the c-statistic.Results: Among 4557 included patients 3742 received a CT (82%). In 383 patients (8.4%) a traumatic finding was present on CT. A potential neurosurgical lesion was found in 73 patients (1.6%) with 26 (0.6%) patients that actually had neurosurgery or died as a result of traumatic brain injury. The original CHIP underestimated the risk of traumatic (intra)cranial findings in low-predicted-risk groups, while in high-predicted-risk groups the risk was overestimated. The c-statistic of the original CHIP model was 0.72 (95% CI 0.69-0.74) and it would have missed two potential neurosurgical lesions and one patient that underwent neurosurgery. The updated model performed similar to the original model regarding traumatic (intra)cranial findings (c-statistic 0.77 95% CI 0.74-0.79, after crossvalidation c-statistic 0.73). The updated CHIP had the same CT rate as the original CHIP (75%) and a similar sensitivity (92 versus 93%) and specificity (both 27%) for any traumatic (intra)cranial finding. However, the updated CHIP would not have missed any (potential) neurosurgical lesions and had a higher sensitivity for (potential) neurosurgical lesions or death as a result of traumatic brain injury (100% versus 96%).Conclusions: Use of the updated CHIP decision rule is a good alternative to current decision rules for patients with MHI. In contrast to the original CHIP the update identified all patients with (potential) neurosurgical lesions without increasing CT rate. [ABSTRACT FROM AUTHOR]

Introduction: In trauma patients using warfarin, current guidelines recommend computed tomography of the brain (CTH), 24-hour observation, and repeat CTH to monitor for stability. Despite growing evidence of uncommon delayed hemorrhage, this remains standard practice even in mild traumatic brain injury without intracranial hemorrhage (ICH). Our study sought to determine the incidence and outcomes of delayed ICH (DICH) in trauma patients on supra-therapeutic warfarin without initial ICH.Methods: A retrospective, single institutional study was performed of all adult trauma patients (>18 years old) who presented on prehospital warfarin with an international normalized ratio (INR) >3 and initial CTH that did not demonstrate ICH. Each of these patients underwent subsequent CTH within 24 hours and any DICH was identified. Those who demonstrated DICH were further examined to identify potential risk factors and outcomes such as need for further imaging or surgical intervention. Analyses were performed using Fisher's exact tests and Student's t-tests.Results: 225 patients were identified from January 2015 to April 2021 that met inclusion criteria. Of those identified, only 3 (1.33%) were found to develop any DICH on routine repeat CTH. Identified characteristics did not reach statistical significance due to the low number of DICH. None of the patients with DICH went on to require intervention.Conclusion: In patients with identified traumatic injury on supra-therapeutic warfarin, an initial CTH without identified ICH alone is an adequate survey. DICH in these patients is uncommon and routine reimaging within 24 hours is unlikely to change clinical management in patients with intact neurologic status. [ABSTRACT FROM AUTHOR]

Introduction: Much of the research impacting diagnosis, outcome, and treatment of traumatic brain injuries (TBIs) has favored time of consciousness criteria indicative of hemispheric blast focus alone. However, recent animal-based research has widely expanded the diagnostic knowledge base and potential treatment options.Methods: Recent animal-based research findings of foramen magnum and occipital crest-focused blast injuries in laboratory rats were reviewed and compared to the Part I human case report.Results: Comparing the human case report (Part I) to that of animal research studies found very similar neuropathological outcomes, many deep and delayed, and supports why non-cerebral-focused TBIs have gone unrecognized. The overpressure wave is funneled through skull openings of the foramen magnum, with the possibility of a rebound secondary contrecoup injury impacting the orbits, oral-nasal cavity, and ears resulting in additional occult axonal and white matter injury.Conclusions: Research analysis prompted by a human case report (Part I) has helped identify mechanisms that assist in recognizing and defining non-cerebral hemispheric-focused TBI injuries. Position of the head in relationship to the blast wave, the setting in which the blast occurs, and close diagnostic follow-up are critical to the recognition, diagnosis, and treatment of injuries that have otherwise gone unrecognized and unstudied in humans since the Vietnam War. [ABSTRACT FROM AUTHOR]

Background: Cisternostomy has recently been reintroduced in the setting of severe TBI as an adjuvant surgical technique for decreasing brain edema and refractory intracranial hypertension. However, there is not much clarity regarding its role in head injury.Objective: Study the effect of cisternostomy on intracranial pressure, morbidity, and mortality in head-injured patients.Material and Methods: We conducted a single-center quasi-experimental study between November 2018 and November 2020. All candidates for decompressive hemicraniectomy (DHC) were divided into two groups: DHC-BC (undergoing basal cisternostomy with DHC) and DHC (undergoing DHC alone). We compared the impact of surgery on decreasing ICP and clinical outcomes in both groups.Results: During the study duration, we admitted 659 head-injury patients. Forty patients were included in the study (9 in the DHC-BC group and 31 in the DHC group). Both the groups were comparable in terms of baseline clinical characteristics such as age, gender, preoperative GCS, head injury severity, radiological features, and opening ICP. Patients in both groups had a decline in ICP following surgery. The mean closing pressure in the DHC-BC group (11.3 ± 5.9) was significantly higher than that in the DHC group (5.3 ± 3.5) (P = 0.003). The mean drop in ICP in the DHC-BC group was 14.4 ± 11.5 while that in the DHC group was 18.9 ± 12.4 (P = 0.359). The average total number of hours of ICP >20 mm Hg and intracranial hypertension index were higher for the DHC-BC group. The average number of days of stay in the ICU and hospital were lower for the DHC-BC group (7.0 ± 6.1 and 15.0 ± 20.2, respectively) compared to the DHC group (10.6 ± 9.3 and 19.3 ± 13.9, respectively). The 30-day mortality rate was higher for the DHC-BC group (66.6%) than the DHC group (32.2%). The mean GCS at discharge was better in the DHC-BC group (11.7 ± 2.9) compared to 10.5 ± 3.7 in the DHC group, while 11.1% of patients in the DHC-BC group had a favorable outcome (1-month GOS-E) compared to 9.7% patients in the DHC group.Conclusions: Our preliminary single-center study failed to show a clear benefit of adding basal cisternostomy to decompressive hemicraniectomy in patients with head injuries. [ABSTRACT FROM AUTHOR]

Purpose: Contact sport athletes are exposed to a unique environment where they sustain repeated head impacts throughout the season and can sustain hundreds of head impacts over a few months. Accordingly, recent studies outlined the role that head impact exposure (HIE) has in concussion biomechanics and in the development of cognitive and brain-based changes. Those studies focused on time-bound effects by quantifying exposure leading up to the concussion, or cognitive changes after a season in which athletes had high HIE. However, HIE may have a more prolonged effect. This study identified associations between HIE and concussion incidence during different periods of the college football fall season. Methods: This study included 1120 athlete seasons from six National Collegiate Athletic Association Division I football programs across 5 yr. Athletes were instrumented with the Head Impact Telemetry System to record daily HIE. The analysis quantified associations of preseason/regular season/total season concussion incidence with HIE during those periods. Results: Strong associations were identified between HIE and concussion incidence during different periods of the season. Preseason HIE was associated with preseason and total season concussion incidence, and total season HIE was associated with total season concussion incidence. Conclusions: These findings demonstrate a prolonged effect of HIE on concussion risk, wherein elevated preseason HIE was associated with higher concussion risk both during the preseason and throughout the entire fall season. This investigation is the first to provide evidence supporting the hypothesis of a relationship between elevated HIE during the college football preseason and a sustained decreased tolerance for concussion throughout that season. [ABSTRACT FROM AUTHOR]

Objective: To examine the long-term effects of amateur boxing in a representative population sample of men. Design: The sample was examined every 5 years for 35 years. Cognition was assessed repeatedly from the third examination. Previous boxing experience and dementia were assessed at the fifth examination, and dementia assessed subsequently through medical records. Setting and Assessment of Rick Factors: The Caerphilly Prospective Study investigates risk factors for a range of chronic diseases of diseases. These include life style and behavior, together with biological factors relevant to vascular disease. Participants: 1123 adult men aged 45 to 59 years at baseline, followed for 35 years. Main Outcome Measures: Cognitive impairment. Results: A report by a subject of having boxed "seriously" when younger was associated with a 2-fold increase in cognitive impairment [odds ratio (OR) = 2.27; 95% confidence intervals = 1.18-4.38]. For amnestic (Alzheimer-like) impairment, this rises to OR = 2.78 (95% confidence limits 1.37–5.65). Having boxed is associated with an "advancement" in the onset of the dementia (4.8 years; 95% confidence limits 0.9-8.8 years). Conclusions: Amateur boxing is associated with an increased risk and an earlier onset of cognitive impairment and dementia. [ABSTRACT FROM AUTHOR]

Background Gait impairments have been well-studied in concussed athletes. However, the sex-specific effect of cumulative head impacts on gait is not well understood. When a cognitive task is added to a walking task, dual-task gait assessments can help amplify deficits in gait and are representative of tasks in everyday life. Dual-task cost is the difference in performance from walking (single-task) to walking with a cognitive load (dual-task). Purpose The objectives of this study were to explore the differences between sexes in 1) dual-task gait metrics, 2) gait metric changes from pre-season to post-concussion and post-season, and 3) the dual-task costs associated with gait metrics. Study Design Cross-sectional study Methods Over two seasons, 77 female athlete-seasons and 64 male athlete-seasons from collegiate club rugby teams participated in this study. Subjects wore inertial sensors and completed walking trials with and without a cognitive test at pre-season, post-season, and post-concussion (if applicable). Results Females athletes showed improvement in cadence (mean = 2.7 step/min increase), double support time (mean = -0.8% gait cycle time decrease), gait speed (mean = 0.1 m/s increase), and stride length (mean = 0.2 m increase) in both task conditions over the course of the season (p < 0.030). Male athletes showed no differences in gait metrics over the course of the season, except for faster gait speeds and longer stride lengths in the dual-task condition (p < 0.034). In all four gait characteristics, at baseline and post-season, females had higher dual-task costs (mean difference = 4.4, p < 0.003) than the males. Conclusions This results of this study showed little evidence suggesting a relationship between repetitive head impact exposure and gait deficits. However, there are sex-specific differences that should be considered during the diagnosis and management of sports-related concussion. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the use of acrylic bone cement with a Tutopatch collagen implant for frontal sinus obliteration after mucocele excision using a subjective assessment of patient satisfaction. Methods: Patients with a recurrent frontal sinus mucocele with posterior table erosion, for whom an endoscopic approach was not feasible, and who underwent osteoplastic frontal sinus obliteration, were included. The post-operative outcomes were evaluated using a non-standardised questionnaire, comparing pre- and post-operative scores. Results: All patients expressed post-operative satisfaction. Except for hyposmia, significant improvements were observed in all symptom scores. No major complications were observed during the post-operative course. Conclusion: Acrylic bone cement with Tutopatch can be effectively used in frontal sinus reconstruction in cases where an endoscopic approach is not feasible. [ABSTRACT FROM AUTHOR]

Head impacts and neurocognition were quantified in 27 intercollegiate male boxers engaged in two, two-minute sparring rounds. Head impacts were measured using Instrumented Boxing Headgear (IBH). Pre and post-sparring neurocognitive performance was compared using two computerized neuropsychological test batteries (CNTs): Immediate Post-concussion Assessment and Cognitive Testing (ImPACT™) and Automated Neuropsychological Assessment Metrics – Military Battery (ANAM4® MIL). An average of 27.63 ± 17.87 impacts above the 9.6 g IBH threshold were recorded per boxer, with average peak linear acceleration of 23.48 ± 15.20 g and average peak rotational acceleration of 1761.40 ± 1064.34 rad/s2. Small, but measurable declines in delayed memory and improvement in response time from pre- to post-bout were noted. Number of impacts and concussion history predicted degraded memory performance. This is a unique quantification of head impacts in collegiate boxing, which were similar in frequency and location, but lower in magnitude as compared to amateur boxing. Improved understanding of impact kinematics may enhance safety in boxing and other contact sports. Subtle post-bout decrements in delayed memory performance and mild improvement in response time reinforce prior research and provide evidence of congruence in our two CNT assessments, which may facilitate comparisons of outcomes across settings utilizing these tests. [ABSTRACT FROM AUTHOR]

One important cause of retinal haemorrhages (RHs) in children is abusive head trauma (AHT). Our programme of research was conducted on children admitted to hospital over a seven‐year period who had RHs as part of their clinical presentation. This paper summarises important findings from previous publications. As a prerequisite, two basic studies were necessary: (i) a method of reporting the precise location of the RH in the retina; and (ii) defining a simple clinical classification of RHs based on the appearance of the retinal layer involved. Because raised intracranial pressure (RICP) is a frequent secondary brain insult following serious adult head injury, causing hypoxic‐ischaemic injury with a resultant poor outcome, it was considered whether such RICP might also cause RHs in children. Detailed, state‐of‐the‐art monitoring methods were used to investigate this relationship along with retinal imaging. Methodical documentation of the type, area and lifespan of RHs meant that it was possible to address the question of predicting AHT from RH numbers and characteristics, and to describe not only the duration of different layer haemorrhages, but also a previously unreported observation that some RHs transiently enlarge over two to three days before resolving normally. 'One important cause of retinal haemorrhages (RHs) in children is abusive head trauma' Key Practitioner Messages: A new retinal zone classification for research and legal purposes has been developed, as well as a simplified five‐point working classification of RHs, based on existing fundoscopic descriptions.In this cohort study, a young age and a high 'dot‐blot' count (>25 intraretinal haemorrhages) are strong predictors of AHT.There is a complex association between the burden of intracranial pressure insult and RHs.Time to resolution of different RHs has been calculated using two‐dimensional RH area pixel counts from sequential retinal imaging. Two patterns of resolution are reported. [ABSTRACT FROM AUTHOR]

Background: The AARS2 gene encodes a mitochondrial alanyl-transfer RNA synthetase. Defects in this gene have been linked with autosomal recessive inheritance of a variety of different clinical phenotypes.Case: A 13 year-old boy developed behavioral and psychiatric problems following a mild head injury. At age 21 he developed tremor, parkinsonism, and eye nystagmus. MRI revealed white matter changes consistent with a leukoencephalopathy. Genetic studies revealed two pathogenic mutations in the AARS2 gene (c.647dupG and c.595C > T).Literature Review: Only 47 cases of AARS2-associated disorders have been reported, with equal numbers of males and females, and age at onset ranging from infancy to 44 years. The most common clinical problems include movement disorders (71%), cognitive impairment (67%), corticospinal signs (64%), behavioral or psychiatric features (46%), and eye signs (34%). Imaging evidence suggestive of leukoencephalopathy is common, but not invariant. Premature ovarian failure is frequent in females, but not universal.Conclusions: Defects in the AARS2 gene are a rare cause for a variety of movement disorders, often associated with brain imaging evidence suggestive of leukoencephalopathy. [ABSTRACT FROM AUTHOR]

Background: The tackle is the in-game activity carrying the greatest risk for concussion in rugby. A recent evaluation of tackle characteristics in rugby union precipitated a rule modification to reduce head impact risk during tackles. This study aims to replicate the work conducted in rugby union by examining the association between tackle characteristics and head injury events in professional rugby league. Methods: There were 446 tackles resulting in a head injury assessment (HIA) and 5,694 tackles that did not result in a head injury from two National Rugby League (NRL) seasons that were reviewed and coded. Tackle height, body position of players, and contact area on an opponent's body were evaluated, with the propensity of each situation to cause an HIA calculated as HIAs per 1000 events. Results: The propensity for tacklers to sustain a head injury was 0.99 HIAs per 1000 tackles, 1.74-fold greater than for the ball carrier (0.57 HIAs per 1000 tackles). There was a 3.2-fold higher risk for an HIA when the tackler was upright compared to bent-at-the-waist. The greatest risk of a tackler HIA occurred when head contact was very low (knee, boot) or high (head and elbow). HIAs were most common following head-to-head impacts. The lowest propensity for tackler HIA was found when the tackler's head was in proximity with the ball carrier's torso. Conclusions: The result of this study replicated the findings in professional rugby union. This has implications for the injury prevention initiatives implemented to reduce HIA risk because the majority of injuries are sustained by the tackler. [ABSTRACT FROM AUTHOR]

Background: Trauma remains a leading cause of death and effective trauma management within a well-developed trauma system has been shown to reduce morbidity and mortality. A trauma registry, as an integral part of a mature trauma system, can be used to monitor the quality of trauma care and to provide a means to compare local versus international standards. Hong Kong and Germany both have highly developed health care services. We compared the performance of trauma systems including outcomes among major trauma victims (ISS > 15) over a 3-year period (2013–2015) in both settings using trauma registry data. Methods: This study was a retrospective analysis of prospectively collected data from trauma registries in Hong Kong and Germany. Data from 01/2013 to 12/2015 were extracted from the trauma registries of the five trauma centers in Hong Kong and the TraumaRegister DGU® (TR-DGU). The study cohort included adults (≥ 18 years) with major trauma (ISS > 15). Data related to patient characteristics, nature of the injury, prognostic parameters to calculate the RISC II score, outcomes and clinical management were collected and compared. Results: Datasets from 1,864 Hong Kong and 10,952 German trauma victims were retrieved from respective trauma registries. The unadjusted mortality in Hong Kong (22.4%) was higher compared to Germany (19.2%); the difference between observed and expected mortality was higher in Hong Kong (+ 2.7%) than in Germany (– 0.5%). The standardized mortality ratio (SMR) in Hong Kong and Germany were 1.138 (95% CI 1.033–1.252) and 0.974 (95% CI 0.933–1.016), respectively, and the adjusted death rate in Hong Kong was significantly higher compared to the calculated RISC II data. However, patients in Hong Kong were significantly older, had more pre-trauma co-morbidities, more head injuries, shorter hospital and ICU stays and lower ICU admission rates. Conclusion: Hong Kong had a higher mortality rate and a statistically significantly higher standardized mortality ratio (SMR) after RISC II adjustment. However, multiple differences existed between trauma systems and patient characteristics. [ABSTRACT FROM AUTHOR]

Background: New direct oral anticoagulants (DOACs) are commonly used in the management of atrial fibrillation and VTE. Currently, there is no strong evidence to support the current practice of routinely repeating computed tomography (CT) head in anticoagulated patients within 24 hours after their first negative CT scan to assess for new and delayed intracranial hemorrhage (ICH). Our hypothesis is that the vast majority will not have new CT scan findings of ICH and those who do would not require any further intervention.Methods: This is retrospective cohort study. IRB approval was obtained. Subjects included adults age ≥ 18 taking DOACs who presented to our level III trauma center with confirmed or suspected blunt head trauma between August 2013 and October 2019 and received at least one head CT scans.Results: 498 Patient encounters met inclusion criteria. Only 19 patients (3.8%) had positive traumatic ICH on the initial CT head. Those had a higher ISS. 420 out of 479 initial negative CT encounters received a second CT head. Only 2 (0.5%) had delayed positive second CT scan for ICH. 95%CI [0.06%, 1.7%] Patients who developed a new ICH on the second CT head after an initial negative CT scan had a lower Glasgow Coma Scale (GCS) on presentation and a higher ISS. None of those patients required neurosurgical intervention CONCLUSION: Our data suggests that the risk of developing a new or delayed traumatic ICH for patients on DOAC on a second CT head within 24 hours following an initial negative CT is very low and when present did not require neurosurgical intervention and thus does not support routinely obtaining a repeat CT head within 24 hours after a negative initial CT scan. Patients presenting with lower GCS and higher ISS had a higher chance of having a delayed ICH. [ABSTRACT FROM AUTHOR]

Purpose: Until now, the diagnosis of optic nerves hemorrhages in abusive head trauma (AHT) has been obtained only in the postmortem setting. The aim of the IRB-approved study was to assess the presence of optic nerves hemorrhages in AHT patients using 3D-SWI. Methods: Thirteen children with a final confirmed multidisciplinary diagnosis of AHT underwent coronal and axial 3D-SWI imaging of the orbits. The presence of optic nerve sheath (ONS) hemorrhages was defined by thickening and marked 3D-SWI hypointensity of the ONS, resulting in mass effect upon the CSF space. Optic nerve (ON) hemorrhages were defined by areas of susceptibility artifacts in the ON parenchyma. Superficial siderosis was defined by susceptibility artifact coating the ON. Furthermore, data about post-traumatic deformity of the ONS at the head of the optic nerve were collected. Results: The average age of the population was 7.9 ± 5.9 months old. The average GCS was 11.8 ± 4.5. The male to female ratio was 7:6. ONS hemorrhages were identified in 69.2% of cases. Superficial siderosis and ON hemorrhages were identified in 38.5 and 76.9% of cases, respectively. 3D-SWI also depicted traumatic deformity of the ONS at the level of the optic nerve head in 10 cases (76.9%). No statistical correlations were identified between RetCam findings and 3D-SWI findings or GCS and ON hemorrhages. Conclusion: This research shows that dedicated MRI with volumetric SWI of the orbits can depict hemorrhages in the ON, ONS, and ONS injury, in AHT victims. [ABSTRACT FROM AUTHOR]

This study is an analysis of five cases of orbital trauma causing proptosis, paralysis of extraocular muscles with or without associated visual failure. All the cases were treated by a ENT and Neurosurgical team. Either a frontal craniotomy or a lateral orbitotomy was performed. Plain X-rays of the skull and Computerised Tomography (C.T. Scanning) were the main investigations. Results were encouraging both functionally and cosmetically. Early diagnosis and an aggressive approach to orbital decompression can achieve good results. [ABSTRACT FROM AUTHOR]