scholarly journals Head home: implementation during COVID-19 pandemic

2021 ◽  
pp. emermed-2020-211007
Author(s):  
Patrick Aldridge ◽  
Rachel Parish ◽  
Heather Castle ◽  
Emma Russell ◽  
Raj Rout ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Head Injury ◽  
Head Injuries ◽  
Wound Infections ◽  
Negative Group ◽  
Entire Cohort ◽  
Scalp Wound ◽  
Competency Based ◽  
The Relationship ◽  
The Brain

BackgroundRecent research suggests that between 20% and 50% of paediatric head injuries attending our emergency department (ED) could be safely discharged soon after triage, without the need for medical review, using a ‘Head Injury Discharge At Triage’ tool (HIDAT). We sought to implement this into clinical practice.MethodsPaediatric ED triage staff underwent competency-based assessments for HIDAT with all head injury presentations 1 May to 31 October 2020 included in analysis. We determined which patients were discharged using the tool, which underwent CT of the brain and whether there was a clinically important traumatic brain injury or representation to the ED.ResultsOf the 1429 patients screened; 610 (43%) screened negative with 250 (18%) discharged by nursing staff. Of the entire cohort, 32 CTs were performed for head injury concerns (6 abnormal) with 1 CT performed in the HIDAT negative group (normal). Of those discharged using HIDAT, four reattended, two with vomiting (no imaging or admission) and two with minor scalp wound infections. Two patients who screened negative declined discharge under the policy with later medical discharge (no imaging or admission). Paediatric ED attendances were 29% lower than in 2018.ConclusionWe have successfully implemented HIDAT into local clinical practice. The number discharged (18%) is lower than originally described; this is likely multifactorial. The relationship between COVID-19 and paediatric ED attendances is unclear but decreased attendances suggest those for whom the tool was originally designed are not attending ED and may be accessing other medical/non-medical resources

scholarly journals Mitigating the Consequences of Subconcussive Head Injuries

2020 ◽  
Vol 22 (1) ◽  
pp. 387-407
Author(s):  
Eric A. Nauman ◽  
Thomas M. Talavage ◽  
Paul S. Auerbach
Keyword(s):  
Head Injury ◽  
Clinical Diagnosis ◽  
Head Injuries ◽  
Tissue Level ◽  
Clinical Neurology ◽  
Subconcussive Injury ◽  
History Of ◽  
Tissue Alteration ◽  
The Brain

Subconcussive head injury represents a pathophysiology that spans the expertise of both clinical neurology and biomechanical engineering. From both viewpoints, the terms injury and damage, presented without qualifiers, are synonymously taken to mean a tissue alteration that may be recoverable. For clinicians, concussion is evolving from a purely clinical diagnosis to one that requires objective measurement, to be achieved by biomedical engineers. Subconcussive injury is defined as subclinical pathophysiology in which underlying cellular- or tissue-level damage (here, to the brain) is not severe enough to present readily observable symptoms. Our concern is not whether an individual has a (clinically diagnosed) concussion, but rather, how much accumulative damage an individual can tolerate before they will experience long-term deficit(s) in neurological health. This concern leads us to look for the history of damage-inducing events, while evaluating multiple approaches for avoiding injury through reduction or prevention of the associated mechanically induced damage.

Disturbances of Consciousness After Head Injuries

1938 ◽  
Vol 84 (349) ◽  
pp. 347-351 ◽  
Author(s):  
E. Guttmann ◽  
C. E. Winterstein
Keyword(s):  
Head Injury ◽  
Head Injuries ◽  
General View ◽  
Mental Symptoms ◽  
Nervous Function ◽  
The Brain ◽  
Recovery Of Consciousness

Among the mental symptoms associated with head injury the psychiatrist rarely happens to see those immediately following the trauma; he is principally concerned with those mental sequelæ that follow recovery of consciousness (E. Mapother). Neither is the neurologist much interested in “cases of simple concussion in which the concussion is usually of brief duration and there is no indication that the brain has been organically injured” (J. P. Martin). Thus they are generally only observed by surgeons, who are usually more interested in other aspects than the psychological or neurophysiological one. Yet these mental symptoms cannot be disregarded if a general view of the disintegration or re-integration of the nervous function after the traumatic impairment is to be formed.

Brain Damage in Fatal Non-Missile Head Injury in Relation to Age and Type of Injury

1989 ◽  
Vol 34 (1) ◽  
pp. 399-401 ◽  
Author(s):  
J.H. Adams ◽  
D. Doyle ◽  
I. Ford ◽  
D.I. Graham ◽  
M. McGee ◽  
...  
Keyword(s):  
Head Injury ◽  
Brain Damage ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Head Injuries ◽  
Diffuse Axonal Injury ◽  
Diffuse Brain Swelling ◽  
Type Of Injury ◽  
The Relationship ◽  
Diffuse Brain

Brain damage in a series of 635 fatal non-missile head injuries has been analysed with particular reference to the age of the patient and the type of injury. The differences in the type of brain damage in relation to age were less than we had anticipated, lending further support to the contention that the aged brain has a reduced potential for recovery. The analysis confirms the relationship between road traffic accidents, diffuse axonal injury, gliding contusions and ‘basal ganglia’ haematomas, and the importance of diffuse brain swelling resulting from a head injury in children.

scholarly journals Microcystic meningioma mimicking an arachnoid cyst

2015 ◽  
Vol 29 (3) ◽  
pp. 279-284 ◽  
Author(s):  
Danil Adam ◽  
Ioana Hornea ◽  
Cristiana Moisescu ◽  
Dragos Iftimie ◽  
Toma Papacocea
Keyword(s):  
Head Injury ◽  
Arachnoid Cyst ◽  
Head Injuries ◽  
Fluid Collection ◽  
Tumor Mass ◽  
Perilesional Edema ◽  
Imaging Characteristics ◽  
The Right ◽  
The Relationship ◽  
Microcystic Meningioma

Abstract Microcystic meningioma is a particular morphopathological form of benign meningiomas, with different imaging characteristics compared to other forms of meningiomas. It is presented the case of an 80 year old woman with repeated head injuries, initially operated for a right fronto-temporo-parietal pericerebral fluid collection. After four years, the patient returned with headache, confusional status, somnolence, symptoms wich appeared after a new head injury. Cerebral CT scan revealed a hypodense lesion in the right sylvian fissure of 5.7/3.5 cm, without perilesional edema, which was interpreted as an arachnoid cyst. Intraoperative, a soft, gelatinfibrous tumor mass was identified, partially adherent to the dura mater and the underlying cortex, which was completely resected. The morphopathological diagnosis was microcystic meningioma. It is discussed the imaging aspect of the presented case compared to the literature data regarding the microcystic meningiomas and the relationship between head traumas and the occurrence of meningiomas.

1. Impaling-Type Head Injury in a Road Traffic Incident

1993 ◽  
Vol 33 (3) ◽  
pp. 261-263 ◽  
Author(s):  
N Ahmad ◽  
A Busuttil
Keyword(s):  
Head Injury ◽  
Brain Stem ◽  
Road Traffic ◽  
Head Injuries ◽  
Facial Bones ◽  
Traffic Incident ◽  
Fence Post ◽  
The Brain

A fatal impaling-type head injury is described in a young man, sustained when he crashed his car while intoxicated, his head being transfixed by a broken wooden fence post. This shattered the facial bones and damaged the brain stem. Other published instances of impaling head injuries are discussed.

Severe Pediatric Head Injury During the Iraq and Afghanistan Conflicts

Neurosurgery ◽  
2015 ◽  
Vol 77 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Paul Klimo ◽  
Brian T. Ragel ◽  
G. Morgan Jones ◽  
Randall McCafferty
Keyword(s):  
Head Injury ◽  
Glasgow Coma Score ◽  
Statistical Significance ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Predictive Ability ◽  
Entire Group ◽  
Entire Cohort ◽  
Pediatric Head Injury ◽  
Male Sex

AbstractBACKGROUND:Much has been written about injuries sustained by US and coalition soldiers during the Global War on Terrorism campaigns. However, injuries to civilians, including children, have been less well documented.OBJECTIVE:To describe the epidemiologic features and outcomes associated with isolated severe head injury in children during Operations Enduring Freedom and Iraqi Freedom (OEF and OIF).METHODS:A retrospective review of children (<18 years old) in the Joint Theater Trauma Registry with isolated head injury (defined as an Abbreviated Injury Score Severity Code >3) and treated at a US combat support hospital in Iraq or Afghanistan (2004–2012). The primary outcome was in-hospital mortality.RESULTS:We identified 647 children with severe isolated head injuries: 337 from OEF, 268 from OIF, and 42 nontheater specific. Most were boys (76%; median age = 8 years). Penetrating injuries were most common (60.6%). Overall, 330 (51%) children underwent a craniotomy/craniectomy; 156 (24.1%) succumbed to their injuries. Admission Glasgow Coma Score was predictive of survival among the entire cohort and each of the individual conflicts. Male sex also significantly increased the odds of survival for the entire group and OEF, but not for OIF. Closed-head injury improved the predictive ability of our model but did not reach statistical significance as an independent factor.CONCLUSION:This is the largest study of combat-related isolated head injuries in children. Admission Glasgow Coma Score and male sex were found to be predictive of survival. Assets to comprehensively care for the pediatric patient should be established early in future conflicts.

Acute Tissue Tear Hemorrhages of the Brain: Computed Tomography and Clinicopathological Correlations

Neurosurgery ◽  
1990 ◽  
Vol 27 (2) ◽  
pp. 208-213 ◽  
Author(s):  
James E. Wilberger ◽  
William E. Rothfus ◽  
Janet Tabas ◽  
Andrew L. Goldberg ◽  
Ziad L. Deeb
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Head Injuries ◽  
Diffuse Axonal Injury ◽  
Closed Head Injury ◽  
Sensitive Information ◽  
Computed Tomographic ◽  
Clinicopathological Correlations ◽  
Closed Head ◽  
The Brain

Abstract Tissue tear hemorrhages (TTHs) are often seen on high-resolution computed tomographic scans after closed head injury. Generally, TTHs have been thought to be visible manifestations of more severe forms of diffuse axonal injury and thus portend a poor prognosis. Computed tomographic scans from 600 patients with head injuries were reviewed: 48 (8%) were found to have TTHs. The clinical spectrum of TTHs was characterized. No direct relationship could be established between either the presence or the number of TTHs and the severity and/or outcome from the head injury in this group, except that patients with TTHs in both the brain stem and the corpus callosum uniformly had a poor outcome. Magnetic resonance imaging provided more sensitive information than computed tomography in evaluating TTHs.

scholarly journals Improved Hemodynamic Status of Head Injured Patients in the Emergency Unit (ER): Literature Review

2021 ◽  
Vol 11 (04) ◽  
pp. 173-180
Author(s):  
Dadi Hamdani ◽  
Fida Husain
Keyword(s):  
Head Injury ◽  
Literature Review ◽  
Head Injuries ◽  
Head Position ◽  
Inclusion Criteria ◽  
Hemodynamic Status ◽  
Head Injured ◽  
Keywords Head Injury ◽  
Injured Patients ◽  
The Brain

Background: Head injury is a serious problem that can lead to death and even death. Handling of head injuries starts from protecting the brain with blood flow to the brain so that hypoxia or brain ischemia does not occur. Hemodynamics is the result of measuring systolic and diastolic blood pressure, pulse rate, and respiratory rate. Objectives: This literature review aims to find out what interventions can be done when there is an increase in hemodynamic status in head injury patients Methods: This database search was conducted by searching on google scholars with the keywords head injury, hemodynamics. The inclusion criteria of this literature review are articles that were researched within the last 5 years with the year published 2015-2020, full text, using the Indonesian language, the article that used is the article. Results: Interventions that can be done when there is an increase in hemodynamic status in head injury patients are giving oxygen and increasing 30o, giving oxygen through a simple mask and head position 30o, giving head-up position 30o compared to 15o position, giving nasal prong oxygenation therapy and murotal therapy Al-Qur'an for 30 minutes 3 times/day. Conclusion: All interventions resulting from this literature review were in the form of giving oxygen and increasing the head 30o, giving oxygen through a simple mask and head position 30o, giving the head position 30o compared to 15o position, giving nasal branch oxygenation therapy, and murotal Al-Qur'an therapy for 30 minutes 3 times/day.

scholarly journals Mutual relationships between head injury and conduct problems in children aged 9 months to 14 years in the UK Millennium Cohort Study

2022 ◽  
Author(s):  
Valerie Brandt ◽  
Charlotte Hall ◽  
Hedwig Eisenbarth ◽  
James Hall
Keyword(s):  
Cohort Study ◽  
Head Injury ◽  
Conduct Problems ◽  
Head Injuries ◽  
Millennium Cohort Study ◽  
Retrospective Reports ◽  
Strengths And Difficulties ◽  
Uk Millennium Cohort Study ◽  
The Uk ◽  
The Relationship

Background: Research suggests a link between acquired head injury and signs of conduct disorder, with a majority of findings based on retrospective reports and comparison samples. The relationship between head injuries and conduct problems and how they may influence one another during development is currently unclear. This study aimed to investigate direct and indirect associations between head injury and conduct problems through to early adolescence. Methods: Data from the UK Millennium Cohort Study was used to investigate the relationship between conduct problems as assessed by the Strengths and Difficulties Questionnaire and parent reported head injury over time, at ages 9 months, 3, 5, 7, 11 and 14 years, using a cross-lagged path analysis. This is data from 18,552 children, participating in a UK cohort study that is representative of the UK population. We included 7,041 (3,308 male) children, who had full information about head injuries and conduct problems at age 14. Results: We found a mutual association between childhood head injuries and conduct problems but with distinct timings: Head injury between 5-7 years predicted greater chance of conduct problems at age 11 and 14 years, while greater conduct problems at 5 years predicted a significantly greater chance of a head injury at age 7-11 years. Conclusions: These findings have important implications for the timing of preventive and ameliorative interventions. Prior to school entry, interventions aiming to reduce conduct problems would appear most effective at reducing likelihood of head injuries in future years. However, equivalent interventions targeting head injuries would be better timed either as children are entering formal primary education, or soon after they have entered.

Central Nervous System Trauma

2018 ◽  
pp. 65-81
Author(s):  
Colin Smith ◽  
R. Ross Reichard
Keyword(s):  
Nervous System ◽  
Head Injury ◽  
Chronic Traumatic Encephalopathy ◽  
Head Injuries ◽  
Abusive Head Trauma ◽  
Subdural Hemorrhage ◽  
Central Nervous System Trauma ◽  
Brain And Spinal Cord ◽  
The Brain

This chapter covers the pathological changes seen in the nervous system, both the brain and spinal cord, as a result of the application of forces, including blunt force, penetrating, and blast head injuries. Forces can result in both focal pathology, such as contusions and subdural hemorrhage, and disseminated pathology, such as diffuse traumatic axonal injury; the macroscopic and microscopic changes of these lesions are discussed. In addition, the age-dependent pathology that may be seen, including abusive head trauma in infants, is discussed. While many of the changes associated with head injury are acute and cause immediate clinical problems, there is discussion of chronic traumatic encephalopathy, an evolving entity possibly associated with the long-term complications of head injury in some individuals.

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