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6 results

  • Chapter 16 - Epidemiology of Findings Claimed to Be Highly Specific for Shaken Baby Syndrome/Abusive Head Trauma, a Prerequisite to Improve Diagnosis of Child Abuse

  • from Section 3 - Science
  • Edited by Keith A. Findley, University of Wisconsin, Madison, Cyrille Rossant, University College London, Kana Sasakura, Konan University, Japan, Leila Schneps, Sorbonne Université, Paris, Waney Squier, John Radcliffe Hospital, Oxford, Knut Wester, Universitetet i Bergen, Norway
  • Book:
    Shaken Baby Syndrome
    Published online:
    07 June 2023
    Print publication:
    08 June 2023, pp 249-258

  • Summary

    A systematic review by the SBU identified evidence gaps in diagnosing shaken baby syndrome. Population epidemiological studies, and clinical epidemiology, case-series and case-control studies, from Sweden, based on health registers (ICD-codes) and records for infants born 1997 to 2014, and forensic investigation, may add information to improve the diagnostic process of infant abuse. Our findings to date can be summarised as: perinatal exposure; small-for-gestational age, preterm, multiple birth, or male sex, increase the risk for SDH (subdural haemorrhage). Infants with chronic SDH more often had an abnormal increase in head circumference before or at the time of diagnosis. Intra- and inter-country differences in abuse diagnosis, and findings attributed to SBS/AHT indicate different prevailing practices and different interpretation of current understanding of injuries caused by abuse. A false-positive diagnosis of abuse is detrimental to the family. Further research on infant abuse, its circumstances and the specific findings indicative of abuse, is urgently needed to support evidence-based child protection, and to keep false positives and false negatives to a minimum.

  • Prevalence and Characteristics of Earthquake-Related Head Injuries: A Systematic Review

  • Yutaka Igarashi, Narumi Matsumoto, Tatsuhiko Kubo, Masahiro Yamaguchi, Ryuta Nakae, Hidetaka Onda, Shoji Yokobori, Yuichi Koido, Hiroyuki Yokota
  • Journal:
    Disaster Medicine and Public Health Preparedness / Volume 16 / Issue 3 / June 2022
    Published online by Cambridge University Press:
    05 May 2021, pp. 1253-1258
  • Objective:

    We conducted a systematic review to determine the prevalence and characteristics of earthquake-associated head injuries for better disaster preparedness and management.

    Methods:

    We searched for all publications related to head injuries and earthquakes from 1985 to 2018 in MEDLINE and other major databases. A search was conducted using “earthquakes,” “wounds and injuries,” and “cranio-cerebral trauma” as a medical subject headings.

    Results:

    Included in the analysis were 34 articles. With regard to the commonly occurring injuries, earthquake-related head injury ranks third among patients with earthquake-related injuries. The most common trauma is lower extremity (36.2%) followed by upper extremity (19.9%), head (16.6%), spine (13.1%), chest (11.3%), and abdomen (3.8%). The most common earthquake-related head injury was laceration or contusion (59.1%), while epidural hematoma was the most common among inpatients with intracranial hemorrhage (9.5%) followed by intracerebral hematoma (7.0%), and subdural hematoma (6.8%). Mortality rate was 5.6%.

    Conclusion:

    Head injuries were found to be a commonly occurring trauma along with extremity injuries. This knowledge is important for determining the demands for neurosurgery and for adequately managing patients, especially in resource-limited conditions.

  • Repair of frontal sinus fractures: clinical and radiological long-term outcomes

  • E E Alon, E Glikson, Y Shoshani, A Dobriyan, R Yahalom, A Yakirevitch
  • Journal:
    The Journal of Laryngology & Otology / Volume 135 / Issue 5 / May 2021
    Published online by Cambridge University Press:
    21 April 2021, pp. 448-451
    Print publication:
    May 2021
  • Objective

    The long-term clinical and radiological outcomes of patients surgically treated for frontal sinus fracture were assessed.

    Methods

    A retrospective, single-centre analysis was conducted of patients treated for frontal sinus fracture in a tertiary trauma centre between 2000 and 2017. Patients who underwent surgical repair for frontal sinus fracture followed by clinical and radiographical evaluation for at least six months were included.

    Results

    Of 338 patients admitted with frontal sinus fracture, 77 were treated surgically. Thirty patients met the inclusion criteria for long-term follow-up. The average follow-up duration was 37 months (range, 6–132 months). Reconstruction, obliteration and cranialisation of the frontal sinus fracture were performed in 14, 9 and 7 patients, respectively. Two patients with a reconstructed frontal sinus and one with an obliterated frontal sinus developed mucoceles. One patient developed forehead disfigurement following obliteration.

    Conclusion

    Long-term complications of frontal sinus repair using the chosen repair techniques are rare, but patients need to be made aware of these potential complications.

  • A large case series of temporal bone fractures at a UK major trauma centre with an evidence-based management protocol

  • H Kanona, C Anderson, A Lambert, R Al-Abdulwahed, L O'Byrne, N Vakharia, D Motter, C Offiah, A Adams, K Seymour, M J Wareing
  • Journal:
    The Journal of Laryngology & Otology / Volume 134 / Issue 3 / March 2020
    Published online by Cambridge University Press:
    03 March 2020, pp. 205-212
    Print publication:
    March 2020
  • Objective

    To review the management of temporal bone fractures at a major trauma centre and introduce an evidence-based protocol.

    Methods

    A review of reports of head computed tomography performed for trauma from January 2012 to July 2018 was conducted. Recorded data fields included: mode of trauma, patient age, associated intracranial injury, mortality, temporal bone fracture pattern, symptoms and intervention.

    Results

    Of 815 temporal bone fracture cases, records for 165 patients met the inclusion criteria; detailed analysis was performed on the records of these patients.

    Conclusion

    Temporal bone fractures represent high-energy trauma. Initial management focuses on stabilisation of the patient and treatment of associated intracranial injury. Acute ENT intervention is directed towards the management of facial palsy and cerebrospinal fluid leak, and often requires multidisciplinary team input. The role of nerve conduction assessment for immediate facial palsy is variable across the UK. The administration of high-dose steroids in patients with temporal bone fracture and intracranial injury is not advised. A robust evidence-based approach is introduced for the management of significant ENT complications associated with temporal bone fractures.

  • Contrecoup injury in patients with traumatic temporal bone fracture

  • Z A Asha'Ari, R Ahmad, J Rahman, N Kamarudin, L Wan Ishlah
  • Journal:
    The Journal of Laryngology & Otology / Volume 125 / Issue 8 / August 2011
    Published online by Cambridge University Press:
    27 April 2011, pp. 781-785
    Print publication:
    August 2011
  • Objective:

    To study the prevalence and patterns of contrecoup injury in traumatic temporal bone fracture cases.

    Method:

    A prospective, cohort study was undertaken of all patients with traumatic head injury admitted to a tertiary referral hospital in Malaysia within an 18-month period. High resolution computed tomography scans of the brain and skull base were performed in indicated cases, based on clinical findings and Glasgow coma score. Patients with a one-sided temporal bone fracture were selected and subsequent magnetic resonance imaging performed in all cases. Contrecoup injury incidence, type, severity and outcome were recorded.

    Results:

    Of 1579 head injury cases, 81 (5.1 per cent) met the inclusion criteria and were enrolled in the study. Temporal bone fractures were significantly associated with intracranial injuries (p < 0.001). The incidence of a contrecoup injury in cases with temporal bone fracture was 13.6 per cent. Contrecoup injury was significantly associated with petrous temporal bone fracture (p < 0.01). The commonest contrecoup injury was cerebral contusion, followed by extradural haematoma and subdural haematoma.

    Conclusion:

    Contrecoup injury is not uncommon in cases of temporal bone fracture, and is significantly associated with petrous temporal bone fracture.

  • 30 - CT Imaging of the Head

  • from PART III - COMPUTED TOMOGRAPHY
  • Edited by J. Christian Fox, University of California, Irvine
  • Book:
    Clinical Emergency Radiology
    Published online:
    07 December 2009
    Print publication:
    29 September 2008, pp 420-437

  • Summary

    Head computed tomography (CT) is one of the most common imaging studies ordered from the ED. Head CT is used in the evaluation of the patient who presents with headache, altered mental status, suspected stroke, or other acute neurological abnormalities. Current third-generation CT scanners are very sensitive for the detection of acute hemorrhage and bony injury, the two principal pathologies sought in evaluation of patients with head injury. In the patient with head injury, head CT will readily identify skull fractures, although fractures through the thinnest areas of the base of the skull may be missed in the axial cuts. In patients with altered mental status and other neurological abnormalities, head CT is extremely valuable in detecting pathology that requires emergent intervention. The vast majority of head CTs performed in the ED are done without contrast. Artifact is an important consideration in the interpretation of head CTs.