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.

Inappropriate Discharge Instructions for Youth Athletes Hospitalized for Concussion

PEDIATRICS ◽  
1995 ◽  
Vol 95 (2) ◽  
pp. 216-218
Author(s):  
Frank J. Genuardi ◽  
William D. King
Keyword(s):  
Head Injury ◽  
Injury Severity ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Medical Society ◽  
Discharge Instructions ◽  
Youth Athletes ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Grade 3

Objective. To evaluate the medical care, especially the discharge instructions regarding return to participation, received by youth athletes hospitalized for a closed head injury. Methods. We examined the records of all patients admitted over a 5-year period (1987 through 1991) to The Children's Hospital of Alabama for a sports-related closed head injury. Descriptive information was recorded and discharge instructions reviewed. Injury severity was graded according to guidelines current during the study period, as well as those outlined most recently by the Colorado Medical Society, which have been endorsed by a number of organizations including the American Academy of Pediatrics. Discharge instructions recorded for each patient were then compared with those recommended in the guidelines. Results. We identified 33 patients with sports-related closed head injuries. Grade 1 concussions (least severe) occurred in 8 patients (24.2%), grade 2 in 10 (30.3%), and grade 3 (most severe) in 15 (45.4%). Overall, discharge instructions were appropriate for only 10 patients (30.3%), including all with grade 1 concussions, but only 2 with a grade 2 (20.0%) and none with a grade 3 concussion. Conclusion. All who care for youth athletes must become familiar with the guidelines for management of concussion to provide appropriate care and counseling and to avoid a tragic outcome.

A prospective analysis of the recovery of attention following pediatric head injury

1999 ◽  
Vol 5 (1) ◽  
pp. 48-57 ◽  
Author(s):  
CATHY CATROPPA ◽  
VICKI ANDERSON ◽  
ROBYN STARGATT
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Closed Head Injury ◽  
Prospective Analysis ◽  
Speed Of Processing ◽  
Pediatric Head Injury ◽  
Injury Group ◽  
Closed Head ◽  
Ongoing Development ◽  
Over Time

Little is known about specific attentional sequelae following a closed head injury, their pattern of recovery or their interaction with ongoing development. The present study examined attentional abilities in a group of children who had sustained a mild, moderate, or severe head injury. Results showed that the severe head injury group exhibited greater deficits on a number of attentional measures at acute and 6 months postinjury phases, in comparison to children in the mild and moderate head injury groups. Specifically, deficits were most evident on timed tasks where speed of processing was an integral component. Difficulties persisted to at least 6 months postinjury and so may lead to cumulative deficits over time. (JINS, 1999, 5, 48–57.)

Neuroleptic Malignant Syndrome Complicating Closed Head Injury

Neurosurgery ◽  
1986 ◽  
Vol 18 (2) ◽  
pp. 190-193 ◽  
Author(s):  
Frederick M. Vincent ◽  
J. Eric Zimmerman ◽  
James Van Haren
Keyword(s):  
Creatine Kinase ◽  
Head Injury ◽  
Neuroleptic Malignant Syndrome ◽  
Complete Resolution ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Treatment Modalities ◽  
Dantrolene Sodium ◽  
Closed Head Injuries ◽  
Closed Head

Abstract Lethargy, hyperpyrexia, tremor, and rigidity associated with leukocytosis and elevation of the creatine kinase level occurred in a patient with a closed head injury who was being treated with haloperidol for control of agitation. This constellation of symptoms, known as the neuroleptic malignant syndrome (NMS), partially improved when the neuroleptic medication was stopped, but complete resolution of the syndrome did not occur until the patient was treated with bromocriptine. Because haloperidol is the most widely used medication for the agitation that develops in patients with significant closed head injuries, neurosurgeons should be aware of the NMS. The NMS is caused by neuroleptic medications and may initially present with unexplained hyperpyrexia, leukocytosis, and elevated creatine kinase levels. Halting the neuroleptic, supportive care, and the use of dantrolene sodium and bromocriptine are the treatment modalities of choice for this syndrome, which has a mortality rate of 20 to 30% and may be linked to malignant hyperthermia.

Physiological and metabolic response to isolated closed-head injury

1986 ◽  
Vol 64 (1) ◽  
pp. 89-98 ◽  
Author(s):  
Clifford Scott Deutschman ◽  
Frank N. Konstantinides ◽  
Sandra Raup ◽  
Phudiphorn Thienprasit ◽  
Frank B. Cerra
Keyword(s):  
Head Injury ◽  
Nutritional Support ◽  
Metabolic Response ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Bed Rest ◽  
Nitrogen Excretion ◽  
Fluid Restriction ◽  
Content Type ◽  
Closed Head

✓ Studies of the metabolic and physiological response to closed-head injury have intimated the presence of persistent hypermetabolism. To more fully define and evaluate the metabolic response to head trauma, a prospective study was conducted in patients with isolated closed-head injuries. Metabolic and cardiopulmonary data were obtained for a 7-day period. Patients with multiple injuries or infections, or those who received steroids, were excluded. The basic treatment regimen utilized hyperventilation, bed rest with head elevation, intracranial pressure monitoring, mild fluid restriction, and mannitol as needed. No exogenous nutritional support was given. Intrastudy trends and comparsion with data from unstressed fasting patients and stressed patients were noted. Mean Glasgow Coma Scale scores were 4.4 ± 1.5 initially, but rose to a mean of 8.2 ± 3.7 by Day 7. While the responses of cardiac index, CO2 production, lactate/pyruvate ratio, and arteriovenous O2 content difference (AVO2D) were initially elevated, these parameters declined over the course of 7 days. The AVO2D was equivalent to the fasting level by Day 5. Metabolic data, including most amino acid levels in plasma, showed an initial equivalence to stress control levels and a pattern similar to that in non-stressed control subjects by Day 7. Nitrogen and 3-methyl histidine excretion were persistently elevated for the full 7 days. Patients with isolated closed-head injury seemed to be initially hypermetabolic, but this process appeared to resolve by 1 week; the persistent nitrogen excretion may reflect equilibration of muscle mass to the existing level of activity (bed rest). After the first few days, nitrogen excretion may give an erroneous index of the level of metabolic stress and the type or amount of nutritional support needed.

Treatment of head injuries in the American Civil War

1993 ◽  
Vol 78 (5) ◽  
pp. 838-845 ◽  
Author(s):  
Howard H. Kaufman
Keyword(s):  
Civil War ◽  
Head Injury ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Gunshot Wounds ◽  
American Civil War ◽  
Content Type ◽  
Severity Of Injury ◽  
Surgical History ◽  
Fine Print

✓ At the time of the American Civil War (1861–1865), a great deal was known about closed head injury and gunshot wounds to the head. Compression was differentiated from concussion, but localization of lesions was not precise. Ether and especially chloroform were used to provide anesthesia. Failure to understand how to prevent infection discouraged physicians from aggressive surgery. Manuals written to educate inexperienced doctors at the onset of the war provide an overview of the advice given by senior surgeons. The Union experiences in the treatment of head injury in the Civil War were discussed in the three surgical volumes of The Medical and Surgical History of the War of the Rebellion. Wounds were divided into incised and puncture wounds, blunt injuries, and gunshot wounds, which were analyzed separately. Because the patients were not stratified by severity of injury and because there was no neuroimaging, it is difficult to understand the clinical problems and the effectiveness of surgery. Almost immediately after the war, increased knowledge about cerebral localization and the development of antisepsis (and then asepsis) permitted the development of modern neurosurgery.

scholarly journals Pediatric Head Injury Caused by Off-Road Vehicle Accidents

1989 ◽  
Vol 16 (3) ◽  
pp. 336-339 ◽  
Author(s):  
E.R. Cardoso ◽  
Alexander Pyper
Keyword(s):  
Head Injury ◽  
Spinal Injury ◽  
Head Injuries ◽  
Rural Setting ◽  
Road Vehicles ◽  
Urban Centers ◽  
Average Hospital ◽  
Vehicle Accidents ◽  
Pediatric Head Injury ◽  
Head Injured

ABSTRACT:Morbidity and mortality from pediatric head injuries associated with the use of off-road vehicles are increasing. We reviewed all such injuries admitted to acute care hospitals in the two largest urban centers in Manitoba between April 1979 and August 1986. Of 375 injured children, 83 suffered head injury, 70 boys and 13 girls. Ages ranged from 2 to 15 years, with a mean of 10.4 years. Head injury was defined as any injury involving face, scalp or nervous system. Dirtbikes were implicated in 34 accidents, snowmobiles in 28, 3-wheel ATV's in 19, and 4-wheel ATV's in 2. About 85% of accidents occurred in a rural setting. Loss of vehicle control was the most common cause of injury. Alcohol or drug abuse were not factors. Fifty (60.2%) patients suffered loss of consciousness, prolonged in 6 (7.2%). All head-injured children also suffered at least one associated injury, mainly involving the musculoskeletal system. Associated spinal injury occurred in 18%. The average hospital stay was 13 days. Three (3.6%) patients died as a result of head injury.

scholarly journals Variations in the Presentation of Aphasia in Patients with Closed Head Injuries

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Dara Oliver Kavanagh ◽  
Conor Lynam ◽  
Thorsten Düerk ◽  
Mary Casey ◽  
Paul W. Eustace
Keyword(s):  
Head Injury ◽  
Early Recognition ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Favourable Outcome ◽  
Speech And Language ◽  
Closed Head Injuries ◽  
Closed Head ◽  
The Common ◽  
Surgical Unit

Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome.

scholarly journals Early Seizures after Severe Closed Head Injury

1997 ◽  
Vol 24 (1) ◽  
pp. 40-43 ◽  
Author(s):  
Shih-Tseng Lee ◽  
Tai-Ngar Lui ◽  
Cheuk-Wah Wong ◽  
Yi-Shen Yeh ◽  
Wen-Ching Tzuan ◽  
...  
Keyword(s):  
Head Injury ◽  
Mortality Rate ◽  
Statistical Significance ◽  
Closed Head Injury ◽  
Neurological Recovery ◽  
Lower Mortality ◽  
Closed Head ◽  
Post Traumatic ◽  
Early Seizures ◽  
Parenchymal Damage

ABSTRACT:Background:We studied the incidence and clinical significance of early post-traumatic seizures after severe closed head injury.Methods:This prospective study is based on clinical observation of 3340 adult patients with severe closed head injuries, each of them having a Glasgow Coma Scale (GCS) 3 to 8 after trauma. Anticonvulsant agents were not given to these patients unless there was evidence of seizure.Results:One hundred and twenty-one patients (3.6%) experienced seizures within 1 week after head injury; 42 of these (1.26% of the series) had seizures within 24 hours after trauma. The incidence of intracerebral parenchymal damage was found to be higher among those patients who developed seizures in the first week (66.1%) than in those who did not (62.7%). However this result did not reach statistical significance. The patients with early seizures had a lower mortality rate (p < 0.01). In patients who survived from the initial injury, the occurrence of early post-traumatic seizures did not appear to influence the neurological recovery at 6 months after injury.Conclusion:Presence of intracerebral parenchymal damage on CT scan after severe closed head injury does not increase the risk of early post-traumatic seizures. With proper treatment, patients presenting with early seizures may have a lower mortality rate. However, the occurrence of early seizures does not influence the neurological recovery in patients who survive the initial severe closed head injury.

Controlled lumbar drainage in pediatric head injury

1995 ◽  
Vol 83 (3) ◽  
pp. 453-460 ◽  
Author(s):  
David I. Levy ◽  
Harold L. Rekate ◽  
W. Bruce Cherny ◽  
Kim Manwaring ◽  
S. David Moss ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Head Injury ◽  
Pediatric Patients ◽  
Head Injuries ◽  
Severe Disabilities ◽  
Barbiturate Coma ◽  
Content Type ◽  
Lumbar Drainage ◽  
Pediatric Head Injury ◽  
Lumbar Drain

✓ A retrospective study of external lumbar subarachnoid drainage in 16 pediatric patients with severe head injuries is presented. All patients had Glasgow Coma Scale scores of 8 or lower at 6 hours postinjury and were initially treated with ventriculostomy. Five patients required surgical evacuation of focal mass lesions. All patients manifested high intracranial pressures (ICPs) refractory to aggressive therapy, including hyperventilation, furosemide, mannitol, and in some cases, artificially induced barbiturate coma. After lumbar drainage was instituted, 14 patients had an abrupt and lasting decrease in ICP, obviating the need for continued medical management of ICP. In no patient did transtentorial or cerebellar herniation occur as a result of lumbar drainage. It was also noted retrospectively that the patients in this study had discernible basilar cisterns on computerized tomography scans. Fourteen patients survived; eight made good recoveries, three are functional with disability, and three have severe disabilities. Two patients died, most likely from uncontrolled ICP before the lumbar drain was placed. It is concluded that controlled external lumbar subarachnoid drainage is a useful treatment for pediatric patients with severe head injury when aggressive medical therapy and ventricular cerebrospinal fluid evacuation have failed to control high ICP. Selected patients with elevated ICP, which may be a function of posttraumatic cerebrospinal fluid circulation disruption and/or white matter cerebral edema, can be treated with this modality, which accesses the cisternal spaces untapped by ventriculostomy.

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