Search

Introduction and aim. Computed tomography (CT) is the first imaging modality in the evaluation of children in case of patients with head injury in pediatric Emergency Departments (EDs). Radiological CT reports include not only lesions that are the main cause of the child's complaints but also incidental findings. The objective of this study is to assess incidental findings observed in children who were admitted to the ED and had the head CT performed. Material and methods. This retrospective, cross-sectional study enrolled 644 children under the age of 18, from 1st January 2021 to 31st June 2021. Each child could have had one or more incidental findings in CT Results. Among all CT studies, incidental findings were found in 279 out of 644 (43.32%) cases, of which 73 (11.34%) had both lesions detected incidentally and related to the trauma. Conclusion. Head CT is an incredibly useful tool in the assessment of some head emergencies. However, evaluation of the prevalence of incidental findings is difficult. Most of them require no specific further investigation. Pediatricians, who order CTs in children, must be prepared to interpret and communicate findings to families and introduce treatment in necessary situations. [ABSTRACT FROM AUTHOR]

Previous studies demonstrate racial disparities in child abuse evaluations even after controlling for health insurance coverage. We conducted a cross-sectional study using the Military Health System Data Repository (MDR) of Military Health System (MHS) beneficiaries born between fiscal years 2016 and 2018 to evaluate racial disparities and other factors in the suspicion of child abuse. We observed beneficiaries for 2.5 years after birth and assessed the incidence of head injury using diagnostic codes. Among children with head injury codes, we performed a multivariable logistic regression analysis to measure the association between race and the concurrent use of the diagnostic code for suspected child abuse (SCA) or for the performance of a skeletal survey. There were 195,893 infants included and 45,269 (23.1%) underwent evaluations for head injury. Less than one percent (n = 424) concurrently had the diagnostic code for SCA or a skeletal survey performed within 2 weeks of the head injury evaluation. When controlling for other factors, race was not associated with SCA. Higher military rank was independently associated with decreased odds of SCA. Racial disparities in SCA may be mitigated in the MHS, and further evaluation is needed. Military rank could be a factor in SCA disparities and warrants further study. [ABSTRACT FROM AUTHOR]

The article presents a case of unequal pupil size in a 6-year-old boy following head trauma, later diagnosed as pharmacologic mydriasis due to exposure to angel's trumpet flowers. Topics include the differential diagnosis of anisocoria, the toxic effects of angel's trumpet containing alkaloids like atropine and scopolamine, and the management of anticholinergic toxicity in children.

Strokes represent a major health problem that threatens many people at different stages of their lives. They are one of the most common diseases, as they are considered the second cause of death and the main cause of neurological dysfunction that may lead to permanent neurological impairments. CT scanning is useful in evaluating the cerebral blood supply, distinguishing treatable tissues, and determining the true size of cerebral clots in their early stages. CT scan of the head is an important diagnostic method for developing a three-dimensional image of the skull, brain, and other related areas of the head. A CT scan of the head can provide more details than traditional X-rays, which is especially useful when the doctor wants to examine the blood vessels and soft tissues of the body. Using modern CT imaging, a comprehensive view of the total cerebral circulation and microcirculation can be obtained within minutes for strokes and severe head injuries. The aim of this research was to evaluate the role of CT scan in the comprehensive and early diagnosis of strokes and severe head injuries. The general principles of multi-segment CT scanning, the possibility of their application, and the extent of their importance in cases of strokes were also clarified. From what has been studied, it is clear that multi-section CT scanning gives highly accurate and sensitive diagnostic results in the comprehensive diagnosis of cases of strokes and severe head injuries in their early stages, which positively affects the treatment strategy. Comprehensive CT scanning is a fast and safe method that allows accurate diagnosis and opens the way for individualized treatment in acute stroke. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Tepecik Education & Research Hospital / İzmir Tepecik Eğitim ve Araştırma Hastanesi Dergisi is the property of Logos Medical 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.)

Background: Child abuse represents an important issue in the medico-legal and social context. In the last few decades, various aspects and mechanisms have been identified in child abuse case studies; however, constant research is needed in the field. With this paper, the authors will present a case of a new entity of Abusive Head Trauma that has come to the attention of medico-legal experts. Discussion: The trauma analysis performed on the cranio-encephalic district of the baby revealed quite peculiar lesions that led the authors to exclude that the injuries had been solely caused by violent shaking of the baby's head, as suggested by Shaken Baby Syndrome. Instead, the authors hypothesised that another lesion mechanism had been added to this one, namely latero-lateral cranial compression. The comprehensive and exhaustive analysis of the case led the authors to present a new possible entity in child abuse trauma, namely 'Compressed Baby Head'. Conclusions: To the best of our knowledge, in the current literature, no similar clinical cases have ever been described. Thus, the case's uniqueness deserves to be brought to the attention of experts and the entire scientific community, as well as medical personnel, paediatricians, and reanimators. These professional figures are the first individuals who may encounter complex clinical cases such as the one presented in this paper; thus, they need to know how to properly manage the case and ensure protection for the abused infants and children. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to develop and validate a list of ICD-10-CM codes identifying abusive head trauma (AHT). METHODS: Subjects included all children under 2 years with head trauma seen in the emergency department or admitted to one of 5 medical centers. Cases were classified as AHT, accidental head injury, or indeterminate based on chart review of the medical record. ICD-10-CM code list to identify cases of AHT was developed based on prior head injury code lists. Sensitivity and specificity of the final code list were calculated. RESULTS: There were 2883 patients in the study population of whom 524 had AHT, 2123 had accidental injury, and 236 were indeterminate cases. The final list of AHT codes had a sensitivity of 76.1% (95% CI 72.5-79.8) and a specificity of 98.5% (95% CI 98.0-99.0) when limiting analyses to the groups with identified cause of injury (accidental vs abusive). Misclassification of cases based on codes resulting in false positives and false negatives was due to coding errors. CONCLUSIONS: The list of ICD-10-CM codes can be utilized to identify and track cases of AHT at a national level in large administrative datasets though likely underestimates true injury burden. [ABSTRACT FROM AUTHOR]

Advances in low-cost wearable head impact sensor technology provide potential benefits regarding sports safety for both consumers and researchers. However, previous laboratory evaluations are not directly comparable and do not incorporate test conditions representative of unhelmeted impacts. This study addresses those limitations. The xPatch by X2 Biosystems and the SIM-G by Triax Technologies were placed on a National Operating Committee on Standards for Athletic Equipment (NOCSAE) headform with a Hybrid III neck which underwent impact tests using a pendulum. Impact conditions included helmeted, padded impactor to bare head, and rigid impactor to bare head to represent long- and short-duration impacts seen in helmeted and unhelmeted sports. The wearable sensors were evaluated on their kinematic accuracy by comparing results to reference sensors located at the headform center of gravity. Statistical tests for equivalence were performed on the slope of the linear regression between wearable sensors and reference. The xPatch gave equivalent measurements to the reference in select longer-duration impacts, whereas the SIM-G had large variance leading to no equivalence. For the short-duration impacts, both wearable sensors underpredicted the reference. This error can be improved with increases in sampling rate from 1 to 1.5 kHz. Follow-up evaluations should be performed on the field to identify error in vivo. [ABSTRACT FROM AUTHOR]

In the article, the authors present their comments on the alleged false controversies on the diagnosis of abusive head trauma (AHT) in children, particularly the claim that shaking is the principal mechanism of AHT. Other topics include the claim that the reference test on the triad of subdural hematoma (SDH), retinal haemorrhage (RH), and encephalopathy should be a confession or actual witnessing of a child who was shaken, and the use of circular reasoning in AHT diagnosis.

In order to assess the value of magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) in microscopic brain scans. Diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRI) changes over time in patients with traumatic brain injury (TBI) show a relationship between recovery from coma and overall Glasgow prognostic parameters. The value of DTI combined with MRI in evaluating TBI has been investigated. 10 patients with TBI received 10 evaluations of magnetic resonance imaging, DTI and MRI scans. Thalamic plate nucleus, reticular nucleus, and retinal developmental activity were measured in normal controls and TBI coma (2-3 weeks) and mild (>4 weeks) patients. Anisotropy, mean diffusion coefficient, axial diffusion coefficient, and radial diffusion coefficient were measured using MRI together with acetylaspartic acid, choline, creatinine, and lactic acid. Independent control t-tests were conducted between controls and TBI patients, and 1-test paired between moderate and severe injuries, and regression and correlation were evaluated. Evaluated for all measures and treatments. DTI and MRI scores in TBI patients differed from normal controls. DTI and MRI can predict the prognosis of TBI patients better. The limitations of the thalamus-retinal activation system are gradually restored. axial diffusion coefficient and radial diffusion coefficient can be used to evaluate the reliability of comatose patients with TBI. DTI and MRI scans of the patient's brain can predict recovery and guide treatment in TBI coma patients. [ABSTRACT FROM AUTHOR]

Contrast blush (CB) is an area with a density higher than the organ parenchyma in the arterial phase of contrast-enhanced computed tomography (CT). CB may be a sign of contrast medium extravasation, pseudo-aneurysm, arteriovenous fistula, or other conditions; however, the indications for treatment remain unclear. Nevertheless, CB could be used to indicate a fatal scenario, such as delayed splenic rupture. Here, we present two multiple-injury cases of fatal delayed splenic rupture following the nonoperative management of a minor splenic injury. In both cases, despite morphological CT findings being minor on admission, CB was observed, and both patients could not rest owing to factors such as older age, a head injury, and drunkenness. Furthermore, in the CB case that indicated pseudoaneurysm, delayed splenic rupture occurred much earlier after the injury compared to the other case without the possibility of pseudoaneurysm. In conclusion, we recommend transcatheter arterial embolization be urgently performed in a case wherein the presence of a pseudoaneurysm is highly probable and factors such as multiple injuries and inability to rest are involved. [ABSTRACT FROM AUTHOR]

Self-efficacy (SE) can affect athletic training students' progression during their professional education and transition to autonomous clinical practice. It is unclear how course delivery may affect athletic training students' SE in various injury evaluation courses. Determine the relationship of course delivery modality and athletic training students' injury evaluation SE. Cross-sectional investigation. Web-based survey. Ninety-five noncertified National Athletic Trainers' Association student members (38/95 undergraduate athletic training students; 57/95 graduate athletic training students). A 2-part survey including participant characteristic questions and piloted adapted General Self Efficacy (GSE) scales were distributed using the National Athletic Trainers' Association's Research Survey Service. The adapted GSE scales asked participants to rate their agreeance from 1 (not at all true) to 4 (exactly true) for 10 statements focused on injury evaluations in 6 areas. Descriptive statistics were calculated, and nonparametric tests were used to determine the differences in GSE scores based on course delivery modality (online model, hybrid model, and traditional face-to-face model). Measures of central tendencies were also calculated. Only completed surveys (66.4%; 95/143) were included in the analysis (access rate = 14.3%). A significant difference existed between course delivery modality and upper extremity GSE scores (P =.001). No significant differences were found between GSE scores for courses with delivery modalities affected or not affected by the COVID-19 pandemic as well as between athletic training students who had or did not have previous online or hybrid course experiences. As health care education continues to shift toward technology-rich environments, educators can consider offering courses through various delivery modalities to promote didactic and clinical education. However, consideration of the content area and difficulty may be warranted while purposefully planning courses to best address learning objectives and students' SE. [ABSTRACT FROM AUTHOR]

Objective: Many clinicians receive Cranial Computed Tomography (CCT) images or videos by their smartphone. The aim of this study was to evaluate the reliability of the CCT videos that are shared through smartphone in the diagnosis. Methods: The CCT videos that were sent via WhatsApp were examined in 9 sections: soft tissue, bone structure, parenchyma, ventricle, vascular structures, middle ear, orbits, sinuses and the extra axial space. Results: The CCT videos were analyzed in 9 sections; there was a perfect agreement among specialists in one of these sections, good agreement in 6 and poor agreement in 2. When compared with the gold standard, it was shown that 5 out of 9 sections could be an alternative to the gold standard. Conclusions: It may be thought that evaluation of the CCT videos can be obtained with messenger applications such as WhatsApp, which is a cheap, fast and common application. But this study shows that diagnostic images and videos shared through the smartphone by a messenger application can not be an alternative to standard evaluations. [ABSTRACT FROM AUTHOR]

Purpose: Traumatic brain injury is one of the leading causes of disability worldwide. Mild traumatic brain injury (TBI) is the most common and benign form of TBI, usually referred to by the medical term "concussion". The purpose of our systematic review and meta-analysis was to explore the role of serum and CSF neurofilament light chain (NfL) as a potential biomarker in concussion. Methods: We systematically searched PubMed, Web of Science, and Cochrane databases using specific keywords. As the primary outcome, we assessed CSF or serum NfL levels in patients with concussion and head impacts versus controls. The role of NfL in patients with concussion and head impacts compared to healthy controls was also assessed, as well as in sports-related and military-related conditions. Results: From the initial 617 identified studies, we included 24 studies in our qualitative analysis and 14 studies in our meta-analysis. We found a statistically significant increase of serum NfL in patients suffering from a concussion or head impacts compared to controls (p = 0.0023), highlighting its potential role as a biomarker. From our sub-group analyses, sports-related concussion and mild TBI were mostly correlated with increased serum NfL values. Compared to controls, sports-related concussion was significantly associated with higher NfL levels (p = 0.0015), while no association was noted in patients suffering from head impacts or military-related TBI. Conclusion: Serum NfL levels are higher in all patients suffering from concussion compared to healthy controls. The sports-related concussion was specifically associated with higher levels of NfL. Further studies exploring the use of NfL as a diagnostic and prognostic biomarker in mild TBI and head impacts are needed. [ABSTRACT FROM AUTHOR]

The term "shaken baby syndrome" has been replaced by "abusive head trauma (AHT)" based on the mechanism of injury. The reported mortality rate of AHT ranges from 10% to 30%. Up to two-thirds of survivors suffer from serious long-term disabilities. Thus, an expeditious and accurate diagnosis is crucial to prevent further abuse that might result in death or serious disabilities. It remains a challenge for physicians to diagnose AHT when parents do not give a history of trauma in preverbal infants without any external signs. Here, we report a case of a 14-day-old boy who presented with a febrile convulsion without evident external injuries nor history of trauma according to his parents. He was diagnosed with AHT based on MRI findings of subacute subdural hemorrhage, multiple cortical hemorrhages, cerebral edema, and diffuse axonal injury. In conclusion, health care providers should keep in mind that the history of trauma provided by the parents or caregivers might not always be true and that reasonable suspicion of abuse is the most important in the diagnosis of AHT, although neuroimaging plays a pivotal role. Reasonable suspicion of AHT in combination with a thorough physical examination, neuroimaging, and skilled neuroradiologist can improve diagnosis and help victims in a timely manner. [ABSTRACT FROM AUTHOR]

Objective: Sport-related concussion (SRC) is a known risk of contact sports and strategies to minimize risk have been used. We aimed to determine if an independent medical spotter (IMS) identified more SRCs than would otherwise be detected by trained sideline medical staff (SMS). Design: Prospective review of SRCs during competition in the 2019 season and retrospective review of SRCs in the 2015 to 2018 seasons, which also used an IMS. Setting: Division I football games (home and away) of a Big 10 Conference institution. Participants: All football team members who participated in competition. Independent Variables: Occurrence of SRC during competition and whether the IMS or SMS directly visualized the injury. Main Outcome Measures: The total number of SRCs that occurred during competition in the 2015 to 2019 football seasons and whom observed the SRC—SMS or IMS—or if a student athlete reported symptoms after competition. Results: Over the 5-year study period, 24 SRCs occurred during competition. Of those, 19 (79.2%) were observed by SMS, 2 (8.3%) by the IMS, and 3 (12.5%) were reported to SMS after competition ended. Conclusions: Most SRCs are accurately identified by SMS, but a small number were apparent only to the IMS who seemed to add sensitivity in detecting a SRC. Instances remain in which SRC recognition and diagnosis were delayed despite trained SMS and IMS. Clinical Relevance: An IMS allows for a small-added player protection benefit using different vantage points to identify potential SRCs during competition. [ABSTRACT FROM AUTHOR]

Non accidental head injury through shaking, the most common and severe AHT in children, is most often repeated. Therefore, for prevention purposes, the diagnosis should be made as soon as possible to avoid recurrence. Recommendations have been established following a rigorous scientific approach. They describe the diagnostic approach to be followed to eliminate differential diagnoses and objectify the lesions and define the diagnostic criteria to be applied at the end, based on objective data: the lesions and the history reported by the adult. The diagnosis is then ruled out, probable or certain. However, the considerable scientific advances on the subject are opposed by an unfounded denialist current, carried by a few, which must be denounced. Indeed, not identifying violence prevents any prevention at the expense of the child and his or her rights, but also of society. [ABSTRACT FROM AUTHOR]

Objective: Head trauma experienced in contact football is a growing health concern, but limited research has been conducted to assess associations between head trauma exposure and long-term concussion-related symptoms among former college football players. Design: We surveyed 275 former college football players who were at least 10 yrs after competition to determine the association between head trauma exposure and concussion-related symptoms later in life. Respondents provided data on their youth, high school and college playing experience, undiagnosed head injury, diagnosed concussions, and eight concussion-related symptoms. A Poisson regression was conducted to examine the association between playing experience and reported head trauma with reported symptom count, and significance was set at P <= 0.05. /p> Results : Few participants reported diagnosed concussions in college (17.5%), but a large number reported undiagnosed football-related head injuries (68.8%) that might have resulted in a concussion. A few participants (40.7%) reported concussion-related symptoms. After controlling for age, high school football participation, and nonfootball concussions (lifetime), diagnosed concussions in high school or college did not significantly predict concussion symptoms later in life. However, undiagnosed football head injury (range = 1-8 injuries) reported 350%-855% greater concussion-related symptoms later in life. Conclusions : Undiagnosed head injuries, which are less likely to be managed by a healthcare professional, were significantly associated with concussion-related symptoms later in life. These findings suggest that proper identification and management of concussions may prevent later symptoms, but more research is needed to test this conclusion. [ABSTRACT FROM AUTHOR]

Clinical Scenario: A cerebral concussion is a traumatically induced transient disturbance of brain function characterized by a complex pathophysiologic process and is classified as a subset of mild traumatic brain injury. The occurrence of intracranial lesions after sport-related head injury is relatively uncommon, but the possibility of serious intracranial injury (ICI) should be included in the differential diagnosis. ICIs are potentially life threatening and necessitate urgent medical management; therefore, prompt recognition and evaluation are critical to proper medical management. One of the primary objectives of the initial evaluation is to determine if the concussed athlete has an acute traumatic ICI. Athletic trainers must be able promptly recognize clinical signs and symptoms that will enable them to accurately differentiate between a concussion (ie, a closed head injury not associated with significant ICI) and an ICI. The identification of predictors of intracranial lesions is, however, relatively broad. Focused Clinical Question: Which clinical examination findings (ie, clinical signs and symptoms) indicate possible intracranial pathology in individuals with acute closed head injuries? [ABSTRACT FROM AUTHOR]

Aims: The aim was to analyze the homicide pattern in South Kerala from autopsies conducted between 2002 and 2016. Objectives: Exploring the age and gender distribution of death due to homicide, the type and distribution of injuries according to the region of the body, and trends of homicide. We also tried to study the pattern of defense wounds in homicidal cases and characteristics in dyadic deaths (homicide-suicide). Materials and Methods: It was a retrospective descriptive study. The setting was the Department of Forensic Medicine, State Medico-Legal Institute, Government Medical College (GMC), Thiruvananthapuram. All cases of autopsies with an alleged history of homicide, between 2002 and 2016, done at Mortuary of GMC, Thiruvananthapuram, were included in the study. Records of all cases of an alleged history of homicide from January 1, 2002 to December 31, 2016 were perused. Results: 957 cases were analyzed. The annual incidence of homicide is declining after 2012. Young adult males (31-40 years) are the most common group involved (24.97%). Head injury was the most common cause of death (43.68%). The head was the most common area to be affected in fatal blunt force injuries (49%) while the chest was involved commonly in fatal sharp force injuries (36%). Females were more often the homicide victims in murder-suicides. Husband-wife and father-child combination was the most common pairs in dyadic deaths. Conclusion: The characteristics which were associated with the homicides were generally in agreement with the existing forensic literature. The findings encourage examining the motives of homicide and potential sociocultural factors affecting the victims and possibly the assailants. We also found that the murder-suicide cases differed from the homicides requiring a separate domain of understanding and subsequent investigations. [ABSTRACT FROM AUTHOR]

A finite element (FE)–guided mathematical surrogate modeling methodology is presented for evaluating relative injury trends across varied vehicular impact conditions. The prevalence of crash-induced injuries necessitates the quantification of the human body's response to impacts. FE modeling is often used for crash analyses but requires time and computational cost. However, surrogate modeling can predict injury trends between the FE data, requiring fewer FE simulations to evaluate the complete testing range. To determine the viability of this methodology for injury assessment, crash-induced occupant head injury criterion (HIC15) trends were predicted from Kriging models across varied impact velocities (10–45 mph; 16.1–72.4 km/h), locations (near side, far side, front, and rear), and angles (−45 to 45°) and compared to previously published data. These response trends were analyzed to locate high-risk target regions. Impact velocity and location were the most influential factors, with HIC15 increasing alongside the velocity and proximity to the driver. The impact angle was dependent on the location and was minimally influential, often producing greater HIC15 under oblique angles. These model-based head injury trends were consistent with previously published data, demonstrating great promise for the proposed methodology, which provides effective and efficient quantification of human response across a wide variety of car crash scenarios, simultaneously. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the characteristics of older adults patients who suffered a head injury after a ground-level fall in comparison to non-head injury patients as well as the factors associated with severity in those with head injury only.Methods: Patients were classified into two groups, the head injury group and the non-head injury group. The characteristics were compared and factors associated with head injury were evaluated. Factors relating to severe injury in the head injury group were also investigated.Results: The head injury group comprised 42 % of a study subjects. Male sex; fall time of 18:00-23:59; fall location of medical facility, transportation area, and public or commercial facility; fall in an outdoor area; fall during daily activity; alcohol ingestion; fall from stairs; non-slippery floor conditions; concrete flooring; sloped flooring; and presence of obstacles on the floor were risk factors for head injury in the older adults after a ground-level fall. Male sex and age over 70 years; fall time of 00:00-05:59; fall in a residential facility; fall in an indoor area; fall during daily activity; fall from stairs; non-slippery floor conditions; and presence of obstacles on the floor were factors associated with severe injury in the head injury group.Conclusions: Male sex with advanced age, indoor fall, and the presence of obstacles on the floor were risk factors for severe injury in the head injury group in older adults individuals who suffered a ground-level fall. It is necessary to develop appropriate ground-level fall prevention programs by evaluating the individual and environmental characteristics of older adults patients. [ABSTRACT FROM AUTHOR]

Purpose: The diagnosis of abusive head trauma (AHT) is complex and neuroimaging plays a crucial role. Our goal was to determine whether non-neuroradiologists with standard neuroradiology knowledge perform as well as neuroradiologists with experience in pediatric neuroimaging in interpreting MRI in cases of presumptive AHT (pAHT). Methods: Twenty children were retrospectively evaluated. Patients had been diagnosed with pAHT (6 patients), non-abusive head trauma-NAHT (5 patients), metabolic diseases (3 patients), and benign enlargement of the subarachnoid spaces (BESS) (6 patients). The MRI was assessed blindly, i.e., no clinical history was given to the 3 non-neuroradiologists and 3 neuroradiologists from 2 different institutions. Results: Blindly, neuroradiologists demonstrated higher levels of sensitivity and positive predictive value in the diagnosis of pAHT (89%) than non-neuroradiologists (50%). Neuroradiologists chose correctly pAHT as the most probable diagnosis 16 out of 18 times; in contrast, non-neuroradiologists only chose 9 out of 18 times. In our series, the foremost important misdiagnosis for pAHT was NAHT (neuroradiologists twice and non-neuroradiologists 5 times). Only victims of motor vehicle accidents were blindly misdiagnosed as pAHT. No usual household NAHT was not misdiagnosed as pAHT. Neuroradiologists correctly ruled out pAHT in all cases of metabolic diseases and BESS. Conclusion: MRI in cases of suspected AHT should be evaluated by neuroradiologists with experience in pediatric neuroimaging. Neuroradiologists looked beyond the subdural hemorrhage (SDH) and were more precise in the assessment of pAHT and its differential diagnosis than non-neuroradiologists were. It seems that non-neuroradiologists mainly assess whether or not a pAHT is present depending on the presence or absence of SDH. [ABSTRACT FROM AUTHOR]

Two days after admission, a magnetic resonance imaging (MRI) scan confirmed chronic SDH and showed radiological characteristics of BEH (Figure 1C), which, however, were not noticed or described. Abbreviations AHT abusive head trauma BEH benign external hydrocephalus HC head circumference SDH subdural haematoma Benign external hydrocephalus (BEH) is a subtype of hydrocephalus. [Extracted from the article]

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

Background: In 2014, the South Australian coroner recommended that residents of residential aged care facilities (RACF) who had sustained a head injury should be transported to emergency departments (ED) for assessment and a head CT scan, with the view to preventing mortality. The evidence base for the recommendation is unclear. Aims: To determine the rate of emergent intervention (neurosurgery, transfusion of blood products or reversal of anti‐coagulation) in residents transferred to ED with minor head trauma who had their usual cognitive function on ED assessment. Methods: This was a retrospective cohort study by medical records review at two university‐affiliated community ED. Participants were patients from RACF attending ED who had suffered minor head trauma and had their usual cognitive function. Exclusions were altered conscious state, new neurological findings or associated orthopaedic injury requiring hospital admission. The primary outcome was rate of emergent intervention in residents transferred to ED with minor head trauma who had their usual cognitive function on ED assessment. Results: A total of 366 patients was studied; median age 86 years, 45% taking anti‐coagulant/anti‐platelet medication. Eighty per cent underwent head CT. Six per cent had intracranial haemorrhage (ICH; 95% CI 4–8.9%). No patient underwent neurosurgery. One had emergent intervention, reversal of anti‐coagulation (0.3%, 95% CI 0.05–1.5%). Conclusion: The rate of emergent intervention for ICH in patients from RACF who sustained a minor head trauma but had their normal cognitive function was <1%. None underwent neurosurgical intervention. The low rate of intervention seriously challenges the appropriateness of routine transfer and CT for this patient group. [ABSTRACT FROM AUTHOR]

Eosinophilic granuloma (EG) is a benign local bone disease . Here, we report a case of EG and describe the MRI findings which had progressed rapidly after minor head trauma. A 5-year-old healthy boy admitted to our clinic for a rapidly growing skull lesion. He had a minor head trauma history which occurred one month before admission. Computed tomography (CT) scan demonstrated a well defined lytic lesion on frontal bone. Our radiologic diagnosis was EG which was confirmed by the postoperative histopathologic diagnosis. Solitary EG lesions are a common form of Langerhans cell histiocytosis. Although the exact etiology of EG is not clear, autoimmune disorders, inflammation are considered to be etiological factors. Also, minor trauma is considered in etiologic factors. We can suggest with the posttraumatic radiological findings that the minor trauma may be a factor for initiation and aggravation on the pathways of development of EG. [ABSTRACT FROM AUTHOR]

Abusive head trauma (AHT) refers to a well-recognized constellation of injuries caused by the direct application of force to an infant or young child, resulting in trauma to the head, intracranial contents, and/or neck, with potentially devastating health outcomes. Mechanisms of AHT include impulsive injurious acts, such as violent shaking and impact, often due to caregiver frustration or exhaustion. Subdural and retinal hemorrhage, and associated extracranial injury (fractures, abdominal trauma), are common. Suspected victims require laboratory/diagnostic testing and occult injury screening, as well as protective measures by investigative authorities to ensure safety. Medicolegal controversies persist around AHT diagnosis, including alternative hypotheses proffered in court by skeptics despite advances in scientific understanding, biomechanical research, neuroimaging techniques, and perpetrator confessions. Pediatricians play a key role in prevention and reduction of AHT morbidity and mortality through anticipatory guidance and caregiver education about the risks of shaking, normal infant development and behavior, and encouragement of stress reduction strategies. [Pediatr Ann. 2020;49(8):e347-e353.]. [ABSTRACT FROM AUTHOR]

Introduction: Trauma activation requires mobilization of significant resources to be available at short notice. In 2014, the American College of Surgeons Committee on Trauma issued its latest recommendations for care of the injured patient. Amongst trauma activation criteria, elderly patients that fell from any height on anticoagulation were included. We hypothesized that a reduced trauma team could preserve patient safety while reducing time and cost spent. Method: A 'Head Injury Alert' was created to denote anti-coagulated patients with a GCS > 14 who fell from a height of <20 feet. An ED attending, surgical resident and one nurse evaluate the patient with the goal of obtaining a head CT within 30 min of presentation. Data were prospectively acquired from June 2017 to August 2018, which included age, anticoagulation, injury severity score (ISS), time-to-CT, outcomes, missed injuries, disposition and activations requiring escalation of care. Results: Two hundred and seventy-seven head injury activations occurred; 55% of patients were female, while 45% were male. Average age was 78 years old. The most common anticoagulant was Warfarin (31%). 50% of patients were discharged, 47% were admitted, 2% died before disposition and 1% were transferred to a tertiary care center; 7% required admission to the ICU. The average time-to-CT was 25 min and ISS ranged from 0 to 26. Twenty-two patients (7%) presented with positive head CT. Of the five deaths, three patients had intracranial hemorrhage, one pneumonia present on admission and one cardiac arrest. Conclusion: This level III evidence, prospective study suggests head injury alert can be safely applied as a new level of trauma activation at community hospitals. It helps identify a specific patient population and injury mechanism that can be safely triaged using limited resources. With this, community hospitals can maximize their resources and minimize cost, while maintaining patient safety. [ABSTRACT FROM AUTHOR]

An introduction is presented on which discusses several articles in the issue on topics including detecting and diagnosing abusive head trauma (AHT) in children; adverse childhood experiences (ACEs) and attitudes towards harmful parenting behaviours; and physical abuse of children.

Abusive head trauma (AHT) remains a significant cause of morbidity and mortality in the pediatric population, especially in young infants. In the past decade, advancements in research have refined medical understanding of the epidemiological, clinical, biomechanical, and pathologic factors comprising the diagnosis, thereby enhancing clinical detection of a challenging diagnostic entity. Failure to recognize AHT and respond appropriately at any step in the process, from medical diagnosis to child protection and legal decision-making, can place children at risk. The American Academy of Pediatrics revises the 2009 policy statement on AHT to incorporate the growing body of knowledge on the topic. Although this statement incorporates some of that growing body of knowledge, it is not a comprehensive exposition of the science. This statement aims to provide pediatric practitioners with general guidance on a complex subject. The Academy recommends that pediatric practitioners remain vigilant for the signs and symptoms of AHT, conduct thorough medical evaluations, consult with pediatric medical subspecialists when necessary, and embrace the challenges and need for strong advocacy on the subject. [ABSTRACT FROM AUTHOR]

To analyze the relationship between high mobility group protein B1 (HMGB1), transforming growth factor - β1 (TGF- β1) and CT image scores after craniocerebral injury. From February 2017 to December 2018, 93 patients with craniocerebral injury were randomly selected from our hospital. According to the different CT imagescores, the patients were divided into three groups: group 0-5 points (24 cases), group 6-10 points (47 cases), group 11¬15 points (22 cases). The serum levels of high mobility group protein B1 (HMGB1), transforming growth factor - β1 (TGF- β1), interleukin (IL-12), C-reactive protein (CRP), myelin basic protein (MBP), neuron-specific enolase (NSE) and protein S100B (S100B) were measured by ELISA. Glasgow score was used to evaluate the severity of craniocerebral injury. Pearson correlation test was used to analyze the relationship between HMGB1, TGF - β1, MMP-2, MMP-9, IL-12, CRP, Glasgow score, MBP, NSE, S100B and CT image scores. There was no statistical significance (P > 0.05) of the significant difference in the comparison of clinical basic data such as age, gender, body mass index, type of brain injury and the causes of brain injury between each group. With the increase of CT image scores, the levels of HMGB1, IL-12, CRP, MBP, NSE and S100B in serum of the patients increased significantly, the levels of TGF - β1 and Glasgow score in serum decreased significantly (P<0.05). The level of HMGB1, TGF - β1, IL-12, CRP, MBP, NSE, S100B was the lowest in group 0-5 points' serum, and Glasgow was the highest; the group 6-10 points take the second place; the level of HMGB1, TGF - β1, IL- 12, CRP, MBP, NSE, S100B was the highest in group 11-15 points' serum, and Glasgow was the lowest. According to Pearson correlation test analysis, the levels of HMGB1, IL-12, CRP, MBP, NSE and S100B in serum were positively correlated with CT image scores, while the levels of TGF - β1 and Glasgow score were negatively correlated with CT image scores (P < 0.05). The level of HMGB1, IL-12, CRP, MBP, NSE, S100B, TGF - β1 and Glasgow score in serum were significantly correlated with CT image scores. The level of HMGB1, IL-12, CRP, MBP, NSE and S100B in serum level were positively correlated with CT image scores, while serum TGF - β1 levels and Glasgow scores were negatively correlated with CT image scores. All of the above indexes can be used as important indexes for the diagnosis of craniocerebral injury. [ABSTRACT FROM AUTHOR]

Purpose: Computed tomography (CT) for minor head injury exposes a large number of children to ionizing radiation, with an associated increased lifetime risk of malignancy. To study imaging practices for children with minor head injury and the level of awareness of radiologists of the current clinical decision rules for minor traumatic brain injury (TBI). Methods: A questionnaire consisting of 17 questions was distributed electronically to 472 ESPR members. The questionnaire covered demographic information, employment status, years of experience and the current practice setting of the participants, the number of CTs performed for pediatric head trauma, awareness of clinical decision rules and use of shielding, pediatric CT protocol and MRI. Results: The response rate was 18.4%. The majority of participants was aged over 50 years and was full-time consultants. Regarding decision rules, 73.8% of respondents cited the NICE head injury guidelines, and 79% reported that the decision to perform CT was agreed between specialists. Shielding was used by 58.3% and 67.4% applied a specific pediatric protocol. MRI was not used for pediatric head trauma by 70.6% of respondents, although always available in 68.6% of cases. The reported obstacles to MRI use were machine availability (42.7%), the long acquisition time (39%) and patients' intolerance (18.3%), and less frequently the cost and the need for sedation. Conclusion: There is room for decreasing the use of CT for pediatric minor TBI. The use of shielding and application of pediatric CT protocols constitute areas for improvement. [ABSTRACT FROM AUTHOR]

• The post-mortem interval is one of the most important elements in a criminal case; • The state of stomach content can be an indicator for post-mortem interval; • In this case, it helped ruling out a possible professional liability. We present the case of a 69 years old man who was hit by a car while crossing the road. A CT scan of the skull and brain showed fracture of the left occipital bone, bilateral hemispheric subarachnoid hemorrhage, right frontal-temporal-parietal subdural hematoma with a shift of midline structures of 18 mm and complete obliteration of the third ventricle. He showed signs of anisocoria, absence of mobility of all 4 limbs and was immediately intubated and admitted to intensive care. The neurosurgeon was immediately consulted. He underwent drainage of subdural hematoma and two decompressive craniotomies, but died 15 days after the initial trauma. At autopsy, the stomach was full of a greenish poltaceous material. This gave us vital information in reconducting the actual brain death of the man to the immediacy of the investment, helping in the process of ruling out any possible profiles of professional liability. [ABSTRACT FROM AUTHOR]

Meningitis is a potentially life-threatening condition. The clinical manifestation can vary depending on the age of the child. This report presents the case of a 7-year-old male patient who was admitted to ED due to loss of consciousness after a head injury. Upon admission, the patient had seizures. Head CT scan did not show any signs of intracerebral bleeding or cerebral oedema. During hospitalization in the ICU, the patient began to be febrile and inflammatory markers started to rise. Treatment with antibiotics and antiviral agents was administered. Later, meningeal signs were observed. Additional imaging tests revealed ambiguous findings. The patient's symptoms resolved gradually, and he was discharged after 19 days of hospitalization. The final diagnosis was meningitis. This case highlights that the diagnosis of meningitis requires careful investigation and precise examination. This diagnosis should therefore be considered in all patients who present with symptoms concerning for meningitis. [ABSTRACT FROM AUTHOR]

Background: Off-field screening tools, such as the Sports Concussion Assessment Tool (SCAT), have been recommended to identify possible concussion following a head impact where the consequences are unclear. However, real-life performance, and diagnostic accuracy of constituent sub-tests, have not been well characterized. Methods: A retrospective cohort study was performed in elite Rugby Union competitions between September 2015 and June 2018. The study population comprised consecutive players identified with a head impact event undergoing off-field assessments with the World Rugby Head Injury Assessment (HIA01) screening tool, an abridged version of the SCAT3. Off-field screening performance was investigated by evaluating real-life removal-from-play outcomes and determining the theoretical diagnostic accuracy of the HIA01 tool, and individual sub-tests, if player-specific baseline or normative sub-test thresholds were strictly applied. The reference standard was clinically diagnosed concussion determined by serial medical assessments. Results: One thousand one hundred eighteen head impacts events requiring off-field assessments were identified, resulting in 448 concussions. Real-life removal-from-play decisions demonstrated a sensitivity of 76.8% (95% CI 72.6–80.6) and a specificity of 86.6% (95% CI 83.7–89.1) for concussion (AUROC 0.82, 95% CI 0.79–0.84). Theoretical HIA01 tool performance worsened if pre-season baseline values (sensitivity 89.6%, specificity 33.9%, AUROC 0.62, p < 0.01) or normative thresholds (sensitivity 80.4%, specificity 69.0%, AUROC 0.75, p < 0.01) were strictly applied. Symptoms and clinical signs were the HIA01 screening tool sub-tests most predictive for concussion; with immediate memory and tandem gait providing little additional diagnostic value. Conclusions: These findings support expert recommendations that clinical judgement should be used in the assessment of athletes following head impact events. Substitution of the tandem gait and 5-word immediate memory sub-tests with alternative modes could potentially improve screening tool performance. [ABSTRACT FROM AUTHOR]

Purpose: Traumatic subclavian vascular injury (TSVI) is rare but often fatal. The precise diagnosis of TSVI remains challenging mainly because of its occult nature, less typical presentations, and being overlooked in the presence of polytrauma. Compared to penetrating injuries, it is even more difficult to identify TSVI in patients who have blunt injuries and no visible bleeding. The risk factors associated with TSVI in patients with thoracic trauma are unclear. The aims of this study were to identify risk factors for TSVI in a cohort of patients with thoracic vascular injuries and to report outcomes after clinical treatment. Methods: From January 2009 to June 2017, 39586 patients were admitted to our hospital (a level I trauma center) due to trauma, and 136 patients with thoracic vascular injury were enrolled in this study. We retrospectively reviewed data from medical records including demographic characteristics, injury scoring systems (RTS, ISS, NISS, TRISS and AIS), management and outcomes. Patients were further divided into the TSVI group (patients with TSVI) and the non-TSVI group (patients with thoracic vascular injuries other than TSVI). Univariate and multivariate analyses were used to identify independent risk factors. Results: The enrolled 136 patients suffered mostly from blunt trauma (89.0%) and 22 of them had TSVI. When compared to the non-TSVI group, the TSVI group had lower Glasgow Coma Scale (GCS) scores (p = 0.002; especially GCS ≤ 12), less concurrent abdominal injury (p < 0.001), lower Injury Severity Scales (ISS) (p = 0.007) and New Injury Severity Scales (NISS) (p < 0.002) but had higher Abbreviated Injury Scales (AIS) of the head ≥ 3 (p = 0.009) and rates of clavicular or scapular fractures (p = 0.013). No difference was detected between the two groups with regard to age, gender, trauma mechanism, vital signs on arrival, or rate of facial and extremities injury. In multivariate regression analyses, GCS ≤ 12, AIS of the head ≥ 3 and the presence of clavicular or scapular fractures were independent risk factors for TSVI (p = 0.026, p = 0.043 and p = 0.005, respectively) after adjustment for confounding factors. Open and endovascular repair were two surgical procedures utilized for these TSVI patients with an overall mortality rate of 18.2%. No difference was found between these groups with regard to mortality rate and the length of ICU stay, but the patients in the TSVI group had a shorter length of hospital stay. Conclusions: Our results suggest that GCS ≤ 12, AIS of the head ≥ 3 and the presence of clavicular or scapular fractures were independent risk factors for TSVI in patients with thoracic vascular injuries. For patients with thoracic trauma, TSVI should be considered for prompt management when patients exhibit concurrent injuries to the head, clavicle or scapula. [ABSTRACT FROM AUTHOR]

Introduction and purpose: Computerized brain tomography (CBT) imaging plays a key role in the management of patients with head trauma, and there is an indication for CBT in moderate and severe injuries. However, it is difficult to determine an indication for CBT in patients with minor head trauma. The primary aim of this study is to compare the efficiency of the most commonly used clinical decision rules: the guidelines of the Pediatric Emergency Care Applied Research Network (PECARN), and those of the Canadian Assessment of Tomography for Childhood Head Injury (CATCH). Methods: The study, which was designed as a prospective cohort study, sought to determine the appropriate CBT indications for children younger than 18 years who were referred to the emergency department with minor blunt head trauma. The effectiveness of PECARN and CATCH clinical decision rules, which are recommended by literature to be applied in order to diagnose severely injured patients and minimize inappropriate CBT requests, was investigated. All patients included in this study were younger than 18 years of age, were admitted to the study with an isolated blunt head trauma, had a GCS of > 13, and had parental permission to participate in the study. Patients ages 18 and older, those with penetrating head trauma or trauma to other systems, those with GCS ≤ 13, those with incomplete data, and those whose parents did not agree to participate in the study, were excluded. Results: A total of 256 patients were included in the study. PECARN and CATCH rules were both shown to be statistically significant in detecting the presence of pathology (p < 0.001, p = 0.002, respectively). Overall, PECARN was more successful than CATCH in detecting intracranial pathology. The sensitivity of PECARN was 95 (95% CI 72–100%) and specificity was 53 (95% CI 47–60%), while the sensitivity of CATCH was 48 (95% CI 25–71%) and specificity was 83 (95% CI 79–88%). Multivariate regression analyses were performed on the parameters (low GCS, abnormal mental status, age, non-frontal hematoma) and other parameters (vomiting, headache, abnormal behavior according to parents) that were considered to be clinically significant despite having a p value of < 0.3. Age, low GCS, and non-frontal hematoma presence were found to be significant in predicting the presence of pathology. In particular, low GCS increased the probability of pathology 5.94-fold and non-frontal hematoma presence 4.37-fold. Conclusion: While both PECARN and CATCH were found to be effective in determining the necessity of CBT for children with minor blunt head trauma, PECARN proved to be more useful for emergency services because of its higher sensitivity. The authors suggest that conducting a CBT scan based on clinical decision rules may be a suitable approach for early detection of the presence of intracranial acute pathologies in young children with minor blunt head trauma, especially if the GCS score is < 15 and non-frontal hematomas are present. [ABSTRACT FROM AUTHOR]

Few medico-legal matters have generated as much controversy--both in the medical literature and in the courtroom--as Shaken Baby Syndrome (SBS), now known more broadly as Abusive Head Trauma (AHT). The controversies are of enormous significance in the law because child abuse pediatricians claim, on the basis of a few non-specific medical findings supported by a weak and methodologically flawed research base, to be able to "diagnose" child abuse, and thereby to provide all of the evidence necessary to satisfy all of the legal elements for criminal prosecution (or removal of children from their parents). It is a matter, therefore, in which medical opinion claims to fully occupy the legal field. As controversies flare up increasingly in the legal arena, child abuse pediatricians and prosecutors now respond by claiming both that there is actually no real controversy about SBS/AHT, and that it is a purely medical "diagnosis" and not a legal conclusion, so testimony in support of the SBS hypothesis should not be challenged in court. This article, coauthored by four law professors, two physicians, and a physicist, demonstrates that there is very much a live controversy about the SBS/AHT hypothesis and maintains that, under traditional principles of evidence law, physicians should not be permitted to "diagnose" abuse in court (as opposed to identifying specific symptoms or medical findings). [ABSTRACT FROM AUTHOR]

Background: Bicycle riding is a widely practiced mode of transportation, commuting, competition, fitness and recreation. We aimed to describe the incidence, risk factors and outcomes of Bicycle-Related Traumatic Injury (BRTI) in a Middle Eastern country. Methods: Data were extracted from a prospectively collected trauma registry over a period of six years (2010- 2015) from the national trauma center. Demographics and clinical characteristics of patients, and outcomes were analyzed. Results: There were 150 patients with a mean age of 27.2±16.6 years, 98% were males, 86.6% were hit by a car and 8.7% died. The average annual incidence of BRTIs was 1.3 per 100,000 populations. The mean Glasgow Coma Score (GCS) and injury severity score (ISS) were12.7±4.0 and 13.6±9.8; respectively. Almost one-third of cases had an ISS of 9-15. The most commonly injured region was the head (47%) followed by a lower extremity (30%), chest (25%), upper extremity (21.3%), spine (20.7%), abdomen (18.7%) and (7%) pelvis. Conclusions: BRTI is relatively uncommon in Qatar; however, it is characterized by a distinct epidemiology with a considerable mortality. Young male nationals, recreational cyclists and expatriate young commuter cyclists comprise the majority of victims and should be the focus of primary prevention efforts. Complementary prevention should aim at enforcing helmet laws to reduce fatal head injuries, and educating motorists of safer practices around cyclists. [ABSTRACT FROM AUTHOR]

Background: Studies cite the incidence of pediatric blunt cerebrovascular injuries (BCVI) ranges from 0.03% to 1.3%. While motor vehicle incidents are a known high-risk mechanism, we are the first to report on football injuries resulting in BCVI.Case Report: Case 1 is a 14-year-old male football player who presented with slurred speech and facial droop 16 h after injury that had resulted in unilateral stinger on the field. The patient had a negative brain computed tomography (CT) at the onset of symptoms. Given progression of symptoms over the next 24 h, re-evaluation with CT angiography (CTA) of brain and neck showed left internal carotid artery (ICA) dissection, and magnetic resonance imaging of the brain showed left middle cerebral artery infarct. Case 2 is a 16-year-old male football player who presented with headache and right hemiparesis immediately following a tackle injury. CT brain and neck were negative at an outside hospital, but he was transferred to us for progressive symptoms, and then CTA showed a left ICA dissection with distal emboli, including occlusive involvement of the intracranial left ICA. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The diagnosis of BCVI requires a high level of suspicion. Focal neurologic deficits are consistently a risk factor across all screening criteria, including the Denver, Utah, Memphis, and Eastern Association for the Surgery of Trauma. These current screening criteria, however, may not be sufficient to diagnosis BCVI in children. The addition of the mechanism of injury and attention to the patient's clinical presentation and examination are important to prevent missed diagnosis and poor neurologic outcomes. [ABSTRACT FROM AUTHOR]

Traumatic diastasis of cranial sutures is a type of bone fracture more common in children than in adults, but little attention has been paid to this skull damage. Differentiation between inflicted and accidental traumatic head injury is still a challenge in forensic pathology, particularly in pediatric population. In fact, diastasis of cranial sutures may occur with or without other skull fractures and may be the only evidence of an abusive head trauma (AHT). This is a case study dealing with undetected traumatic diastasis of cranial sutures in child abuse. The skeletonized juvenile remains were found inside a suitcase. A diastasis of the coronal and sagittal sutures was the only finding recorded at the autopsy with no other relevant bone defects. The diastasis was originally attributed by the medical examiner to a physiological unfused stage of the calvarial bones. Therefore, the cause of death was undetermined. Twelve years later an anthropological revision of the cold case showed that diastasis of the coronal and sagittal sutures was assessed as the evidence of an AHT. Analysis of skull fractures in child abuse can be challenging as normal skull suture variants mimicking intentional injury are reported. Diastasis of the cranial sutures can be also a post-mortem effect of burning or freezing. Therefore, a differential diagnosis between natural, accidental or inflicted skull defects is mandatory in death investigation. A multidisciplinary approach in such circumstances is strongly recommended in order to reduce the risk of misdiagnosis. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the impact of clinical guidelines for the management of minor head injury on utilization and diagnostic yield of head CT over two decades.Methods: Retrospective before-after study using multiple electronic health record data sources. Natural language processing algorithms were developed to rapidly extract indication, Glasgow Coma Scale, and CT outcome from clinical records, creating two datasets: one based on all head injury CTs from 1997 to 2009 (n = 9109), for which diagnostic yield of intracranial traumatic findings was calculated. The second dataset (2009-2014) used both CT reports and clinical notes from the emergency department, enabling selection of minor head injury patients (n = 4554) and calculation of both CT utilization and diagnostic yield. Additionally, we tested for significant changes in utilization and yield after guideline implementation in 2011, using chi-square statistics and logistic regression.Results: The yield was initially nearly 60%, but in a decreasing trend dropped below 20% when CT became routinely used for head trauma. Between 2009 and 2014, of 4554 minor head injury patients overall, 85.4% underwent head CT. After guideline implementation in 2011, CT utilization significantly increased from 81.6 to 87.6% (p = 7 × 10-7), while yield significantly decreased from 12.2 to 9.6% (p = 0.029).Conclusions: The number of CTs performed for head trauma gradually increased over two decades, while the yield decreased. In 2011, despite implementation of a guideline aiming to improve selective use of CT in minor head injury, utilization significantly increased.Key Points: • Over two decades, the number of head CTs performed for minor, moderate, and severe head injury gradually increased, while the diagnostic yield for intracranial findings showed a decreasing trend. • Despite the implementation of a guideline in 2011, aiming to improve selective use of CT in minor head injury, utilization significantly increased, while diagnostic yield significantly decreased. • Natural language processing is a valuable tool to monitor the utilization and diagnostic yield of imaging as a potential quality-of-care indicator. [ABSTRACT FROM AUTHOR]

Self-report measures, particularly symptom inventories, are critical tools for identifying patients with persistent post-concussion symptoms and their follow-up. Unlike in military or sports-related assessment, in general civilian settings pre-injury levels of concussion-like symptoms are lacking. Normative data are available in adolescent and college populations, but no reference data exist to guide clinical adult explorations. The purpose of this study was to use the second edition of the Sport Concussion Assessment Tool (SCAT2) to profile a cohort of 60 healthy community volunteers who had not sustained a head injury. Participating volunteers underwent MRI scanning and were evaluated with the Hospital Anxiety and Depression Scale (HADS). Participants reported a median of 3 concussion-like symptoms and the 97.5 percentile score was found at 10.5 symptoms, out of a total of 22. The median severity score was 4.9 points, and 28.9 was the upper limit of the reference interval. Only 10 participants (16.7%) did not endorse any symptom. The most frequently endorsed symptom was feeling difficulty in concentrating, with 41.7% of the sample reporting it. Age, sex and general distress, anxiety and depressive symptoms were not associated with concussion-like symptoms. Our data yielded elevated cut-offs scores for both the number of symptoms and the symptom severity. In conclusion, postconcussive-like symptoms are frequent in the general non-concussed adult population and it should be taken into account in any future models developed for screening patients at risk of developing physical, cognitive, and psychological complaints following mild traumatic injury. [ABSTRACT FROM AUTHOR]

The Pediatric Emergency Care Applied Research Network (PECARN) Head Injury/Trauma Algorithm is a well-validated decision rule used to identify patients at low risk of clinically important traumatic brain injuries who may not need head CT. In adult patients with mild head trauma, elevated serum glucose and white cell count (WCC) have been associated with abnormal head CT findings. Currently, glucose or WCC is not considered in pediatric patients. The objective of this study was to determine if elevations in glucose or WCC could be used as additional tools to risk-stratify pediatric trauma patients for intracranial injury (ICI). Data were abstracted from the Maryland Trauma Registry and from electronic medical records for patients at the Johns Hopkins Children's Center from 2017 to 2020. We evaluated 145 encounters that met the inclusion criteria. There were 33 cases of ICI on CT. In addition to higher median glucose and WCC, we found that patients with ICI had a younger median age and were less likely to have other clinically significant injuries than patients without ICI. Following multiple logistic regression analysis, WCC (OR 1.113, 95% CI 1.02 to 1.21), younger age (OR 0.89, 95% CI 0.8 to 0.98), and absence of other injuries (OR 0.41, 95% CI 0.23 to 0.73) were found to be associated with risk of ICI. The area under the curve for our model was 0.79. When used with the PECARN algorithm, our model could help determine which patients may avoid head CT or undergo a shorter observation period. [ABSTRACT FROM AUTHOR]

Background: The primary aim was to investigate the performance of a National Advisory Committee for Aeronautics based predictive model (NACA-BM) for mortality at 14 days and a reference model using motor GCS (GCS-RM). The secondary aim was to compare the models for impaired consciousness of survivors at 14 days (IC-14; GCS ≤ 13).Methods: Patients ≥16 years having sustained TBI with an abbreviated injury scale score of head region (HAIS) of >3 were included. Multivariate logistic regression models were used to test models for death and IC-14. The discrimination was assessed using area under the receiver-operating curves (AUROCs); noninferiority margin was -5% between the AUROCs. Calibration was assessed using the Hosmer Lemeshow goodness-of-fit test.Results: Six hundred and seventy seven patients were included. The median age was 54 (IQR 32-71). The mortality rate was 31.6%; 99 of 438 surviving patients (22.6%) had an IC-14. Discrimination of mortality was 0.835 (95%CI 0.803-0.867) for the NACA-BM and 0.839 (0.807-0.872) for the GCS-RM; the difference of the discriminative ability was -0.4% (-2.3% to +1.7%). Calibration was appropriate for the NACA-BM (χ2 8.42; P = 0. 393) and for the GCS-RM (χ2 3.90; P = 0. 866). Discrimination of IC-14 was 0.757 (0.706-0.808) for the NACA-BM and 0.784 (0.734-0.835) for the GCS-RM; the difference of the discriminative ability was -2.5% (-7.8% to +2.6%). Calibration was appropriate for the NACA-BM (χ2 10.61; P = 0.225) and for the GCS-RM (χ2 6.26; P = 0.618).Conclusions: Prehospital prediction of mortality after TBI was good with both models, and the NACA-BM was not inferior to the GCS-RM. Prediction of IC-14 was moderate in both models. [ABSTRACT FROM AUTHOR]