scholarly journals The burden of traumatic brain injury from low-energy falls among patients from 18 countries in the CENTER-TBI Registry: A comparative cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (9) ◽  
pp. e1003761
Author(s):  
Fiona E. Lecky ◽  
Olubukola Otesile ◽  
Carl Marincowitz ◽  
Marek Majdan ◽  
Daan Nieboer ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Energy Transfer ◽  
Disease Burden ◽  
High Energy ◽  
Low Energy ◽  
Care Pathways ◽  
Main Study ◽  
Brain Scan ◽  
Comparative Cohort Study ◽  
Ct Brain

Background Traumatic brain injury (TBI) is an important global public health burden, where those injured by high-energy transfer (e.g., road traffic collisions) are assumed to have more severe injury and are prioritised by emergency medical service trauma triage tools. However recent studies suggest an increasing TBI disease burden in older people injured through low-energy falls. We aimed to assess the prevalence of low-energy falls among patients presenting to hospital with TBI, and to compare their characteristics, care pathways, and outcomes to TBI caused by high-energy trauma. Methods and findings We conducted a comparative cohort study utilising the CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) Registry, which recorded patient demographics, injury, care pathway, and acute care outcome data in 56 acute trauma receiving hospitals across 18 countries (17 countries in Europe and Israel). Patients presenting with TBI and indications for computed tomography (CT) brain scan between 2014 to 2018 were purposively sampled. The main study outcomes were (i) the prevalence of low-energy falls causing TBI within the overall cohort and (ii) comparisons of TBI patients injured by low-energy falls to TBI patients injured by high-energy transfer—in terms of demographic and injury characteristics, care pathways, and hospital mortality. In total, 22,782 eligible patients were enrolled, and study outcomes were analysed for 21,681 TBI patients with known injury mechanism; 40% (95% CI 39% to 41%) (8,622/21,681) of patients with TBI were injured by low-energy falls. Compared to 13,059 patients injured by high-energy transfer (HE cohort), the those injured through low-energy falls (LE cohort) were older (LE cohort, median 74 [IQR 56 to 84] years, versus HE cohort, median 42 [IQR 25 to 60] years; p < 0.001), more often female (LE cohort, 50% [95% CI 48% to 51%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001), more frequently taking pre-injury anticoagulants or/and platelet aggregation inhibitors (LE cohort, 44% [95% CI 42% to 45%], versus HE cohort, 13% [95% CI 11% to 14%]; p < 0.001), and less often presenting with moderately or severely impaired conscious level (LE cohort, 7.8% [95% CI 5.6% to 9.8%], versus HE cohort, 10% [95% CI 8.7% to 12%]; p < 0.001), but had similar in-hospital mortality (LE cohort, 6.3% [95% CI 4.2% to 8.3%], versus HE cohort, 7.0% [95% CI 5.3% to 8.6%]; p = 0.83). The CT brain scan traumatic abnormality rate was 3% lower in the LE cohort (LE cohort, 29% [95% CI 27% to 31%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001); individuals in the LE cohort were 50% less likely to receive critical care (LE cohort, 12% [95% CI 9.5% to 13%], versus HE cohort, 24% [95% CI 23% to 26%]; p < 0.001) or emergency interventions (LE cohort, 7.5% [95% CI 5.4% to 9.5%], versus HE cohort, 13% [95% CI 12% to 15%]; p < 0.001) than patients injured by high-energy transfer. The purposive sampling strategy and censorship of patient outcomes beyond hospital discharge are the main study limitations. Conclusions We observed that patients sustaining TBI from low-energy falls are an important component of the TBI disease burden and a distinct demographic cohort; further, our findings suggest that energy transfer may not predict intracranial injury or acute care mortality in patients with TBI presenting to hospital. This suggests that factors beyond energy transfer level may be more relevant to prehospital and emergency department TBI triage in older people. A specific focus to improve prevention and care for patients sustaining TBI from low-energy falls is required.

Pathophysiology of ballistic trauma

2016 ◽  
Author(s):  
Michael C. Reade ◽  
Peter D. Thomas
Keyword(s):  
Energy Transfer ◽  
Kinetic Energy ◽  
Pressure Wave ◽  
Mass Movement ◽  
High Energy ◽  
Low Energy ◽  
Wound Contamination ◽  
Blast Fragmentation ◽  
Low Energy Transfer ◽  
Ballistic Trauma

Bullets and other projectiles cause ballistic trauma. Explosions wound by the effect of a blast pressure wave, penetrating fragments propelled by the explosion, the mass movement of gas interacting with the casualty or the environment, and miscellaneous effects. Most blast casualties surviving to hospital care will not have significant pressure wave injury, but some will. Blast fragmentation most commonly resembles other types of low energy transfer ballistic trauma.. The effect of bullets depends on the kinetic energy transferred and the nature of the tissues struck, with energy transfer partly determined by bullet design. Low energy transfer bullets wound by crushing and laceration, limited to the tissues struck. High energy bullets may impart kinetic energy to surrounding tissues, causing a temporary cavity which sucks in debris and damages tissues sometimes well beyond the bullet track. Predicting the extent of devitalization can be difficult at the time of initial inspection. Wound contamination, particularly with soil, may modify the usual conservative approach to initial debridement.

Blunt major trauma: now two different diseases?

2020 ◽  
Vol 81 (4) ◽  
pp. 1-3
Author(s):  
Timothy Coats
Keyword(s):  
Energy Transfer ◽  
Major Trauma ◽  
Trauma System ◽  
High Energy ◽  
Low Energy ◽  
Older Person ◽  
Younger Patients ◽  
Low Energy Transfer ◽  
Set Up ◽  
The Uk

Major trauma in the UK has changed and can now be thought of as two different diseases: the traditional type of high energy transfer major trauma occurring in younger patients, and low energy transfer major trauma (usually an older person falling on one level). The current NHS trauma system is not well set up to treat low energy transfer major trauma – adapting to the changing disease is the next big challenge.

scholarly journals Necessity of In-hospital Neurological Observation for Mild Traumatic Brain Injury Patients with Negative Computed Tomography Brain Scans

2020 ◽  
Author(s):  
Chin Taweesomboonyat ◽  
Anukoon Kaewborisutsakul ◽  
Thara Tunthanathip ◽  
Sakchai Saeheng ◽  
Thakul Oearsakul
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Intracranial Injury ◽  
Mild Tbi ◽  
Brain Scans ◽  
Brain Scan ◽  
Ct Brain ◽  
Neurosurgical Intervention

Objective: The authors aimed to evaluate the necessity of in-hospital neurological observation for mild traumatic brain injury (TBI) patients, who did not have any evidence of intracranial injury from initial computed tomography (CT) brain scans. Material and Methods: We retrospectively reviewed mild TBI patients with initial negative CT brain scans, receiving treatment at Songklanagarind hospital between January and December, 2018. All patients were observed in the emergency department short stay observation unit for 24 hours after injury. Patients’ medical records, initial and official CT brain scan interpretation were collected and analyzed. Results: This study included 493 cases. No patient deteriorated from intracranial injury, while one patient deteriorated from hypoglycemia, associated with his underlying adrenal insufficiency. However, one patient was admitted to the in patient ward, due to a missed diagnosis of acute subdural hematoma from his initial CT interpretation. The incidence of missed intracranial injury from initial CT brain scan interpretation was 1.6%. The need for neurosurgical intervention (in-patient ward admission, anticonvulsant and repeat brain imaging) was 0.2% (1/493). No patient required surgical intervention.Conclusion: Mild TBI patients, with initial negative CT brain scans, have very low risk for deterioration or need of neurosurgical intervention. Patient's underlying major comorbidity may be considered as an indication for in-hospital observation.

Low energy vs. high energy depositional settings and related sedimentary bodies in early Senenian rudist bearing carbonate shelves (central-southern Italy)

2001 ◽  
Vol 28 (1) ◽  
pp. 37-40 ◽  
Author(s):  
Gabriele Carannante ◽  
A. Laviano ◽  
D. Ruberti ◽  
Lucia Simone ◽  
G. Sirna ◽  
...  
Keyword(s):  
Southern Italy ◽  
High Energy ◽  
Low Energy ◽  
Depositional Settings

Clinical and etiological evaluation of secondary seizures by computed tomography and electroencephalogram

2016 ◽  
Vol 5 (10) ◽  
pp. 4982
Author(s):  
Archana Aher* ◽  
Satish Gore
Keyword(s):  
Meta Analysis ◽  
Temporal Region ◽  
Government Medical College ◽  
Occipital Region ◽  
Parietal Region ◽  
Medical College ◽  
Mri Brain ◽  
Brain Scan ◽  
Ct Brain ◽  
Clonic Convulsions

This study was conducted to determine the clinical evaluation and various etiological factors of secondary seizures in patients admitted to Government Medical College, Nagpur. We evaluated 58 patients of secondary seizures from Dec 2011 to Oct 2013. Secondary seizures were defined as case of seizure with CT (brain) or MRI (brain) abnormality1. Out of 58 cases 35 were males and 23 were females. Mean age of study subjects was 34.85. The commonest presenting feature was generalized tonic clonic convulsions (42 patients) followed by focal seizures (16 patients).  Todd’s palsy was observed in 4 cases. Aura was present in 24 cases. According to CT brain scan the aetiology was – neurocysticercosis (34.48%), post stroke (27.59%), tuberculoma (24.14%). Space occupying lesions(SOLs) were present in 8 patients, out of whom 4 had brain tumour, 2 patients had brain abscess, 1 had hydatid cyst and 1 had metastasis. Majority of lesions were located in frontal region (58.62%), followed by in parietal region (44.83%), in temporal region (25.86%) and in occipital region (13.79 % patients). In our study neurocysticercosis was found to be the commonest cause of secondary seizures. As in a meta-analysis it was found that cysticidal drugs result in better outcome in patients of neurocysticecosis, we recommend that the patients of secondary seizures should be identified for the aetiology and treated at the earliest2.

Transportation: Fuel Energies

2017 ◽  
Author(s):  
Peter Rez
Keyword(s):  
Energy Density ◽  
Fossil Fuels ◽  
High Energy ◽  
Ease Of Use ◽  
Low Energy ◽  
High Energy Density ◽  
Nuclear Fuels ◽  
Liquid Hydrocarbons ◽  
Transportation Fuel ◽  
Journey Time

Transportation efficiency can be measured in terms of the energy needed to move a person or a tonne of freight over a given distance. For passengers, journey time is important, so an equally useful measure is the product of the energy used and the time taken for the journey. Transportation requires storage of energy. Rechargeable systems such as batteries have very low energy densities as compared to fossil fuels. The highest energy densities come from nuclear fuels, although, because of shielding requirements, these are not practical for most forms of transportation. Liquid hydrocarbons represent a nice compromise between high energy density and ease of use.

scholarly journals Low-Energy Electron Damage to Condensed-Phase DNA and Its Constituents

2021 ◽  
Vol 22 (15) ◽  
pp. 7879
Author(s):  
Yingxia Gao ◽  
Yi Zheng ◽  
Léon Sanche
Keyword(s):  
Condensed Phase ◽  
Genetic Material ◽  
High Energy ◽  
Dna Lesions ◽  
Low Energy ◽  
Experimental Investigations ◽  
Experimental Conditions ◽  
Strand Breaks ◽  
Sequence Of Events ◽  
Wide Range

The complex physical and chemical reactions between the large number of low-energy (0–30 eV) electrons (LEEs) released by high energy radiation interacting with genetic material can lead to the formation of various DNA lesions such as crosslinks, single strand breaks, base modifications, and cleavage, as well as double strand breaks and other cluster damages. When crosslinks and cluster damages cannot be repaired by the cell, they can cause genetic loss of information, mutations, apoptosis, and promote genomic instability. Through the efforts of many research groups in the past two decades, the study of the interaction between LEEs and DNA under different experimental conditions has unveiled some of the main mechanisms responsible for these damages. In the present review, we focus on experimental investigations in the condensed phase that range from fundamental DNA constituents to oligonucleotides, synthetic duplex DNA, and bacterial (i.e., plasmid) DNA. These targets were irradiated either with LEEs from a monoenergetic-electron or photoelectron source, as sub-monolayer, monolayer, or multilayer films and within clusters or water solutions. Each type of experiment is briefly described, and the observed DNA damages are reported, along with the proposed mechanisms. Defining the role of LEEs within the sequence of events leading to radiobiological lesions contributes to our understanding of the action of radiation on living organisms, over a wide range of initial radiation energies. Applications of the interaction of LEEs with DNA to radiotherapy are briefly summarized.

scholarly journals Low-Energy Pelvic Ring Fractures: A Care Conundrum

2021 ◽  
Vol 12 ◽  
pp. 215145932098540
Author(s):  
Bailey R. Abernathy ◽  
Lisa K. Schroder ◽  
Deborah C. Bohn ◽  
Julie A. Switzer
Keyword(s):  
Acute Care ◽  
Patient Population ◽  
Pelvic Ring ◽  
Fracture Prevention ◽  
Low Energy ◽  
Care Pathways ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Pelvic Ring Fractures ◽  
Rehabilitative Care

Introduction: A need exists for improved care pathways for patients experiencing low-energy pelvic ring fractures. A review of the current literature was performed to understand the typical patient care and post-acute rehabilitation pathway within the US healthcare system. We also sought to summarize reported clinical outcomes worldwide. Significance: Low-energy pelvic ring fracture patients usually do not qualify for inpatient admission, yet they often require post-acute rehabilitative care. The Center for Medicare and Medicaid Services’ (CMS) 3-day rule is a barrier to obtaining financial coverage of this rehabilitative care. Results: Direct admission of some patients to post-acute care facilities has shown promise with decreased cost, improved patient outcomes, and increased patient satisfaction. Secondary fracture prevention programs may also improve outcomes for this patient population. Conclusions: Post-acute care innovation and secondary fracture prevention should be prioritized in the low-energy pelvic fragility fracture patient population. To demonstrate the effect and feasibility of these improved care pathways, further studies are necessary.

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