Trauma: Head and Facial Trauma

2015 ◽  
Author(s):  
Christopher R. Tainter ◽  
Raghu Seethala
Keyword(s):  
Decision Aids ◽  
Head Injuries ◽  
Antiplatelet Agent ◽  
Clinical Decision ◽  
Return To Play ◽  
Facial Trauma ◽  
Left Frontal Lobe ◽  
Mild Tbi ◽  
Computed Tomographic ◽  
Le Fort Classification

Head and facial trauma includes a wide variety of heterogeneous injuries that vary according to cause, severity, management, and outcomes. These injuries are classified as head injuries (the scalp, skull, and brain) and facial injuries (to the eyes, bony structures, nose, mouth, teeth, tongue, and glands and the accompanying nerves, muscles, and vasculature). This review covers the epidemiology, anatomy, assessment and stabilization, diagnosis, treatment and disposition, and outcomes for traumatic brain injury (TBI), scalp and cranial vault trauma, ocular trauma, and facial trauma. Figures show computed tomographic scans showing a large left frontal lobe intraparenchymal hemorrhage, a traumatic subarachnoid hemorrhage, a subdural hematoma, a right occipital epidural hematoma, and a left orbital floor “blowout” fracture; an illustration of the brain herniation syndromes; the anatomy of the globe; and the Le Fort classification scheme of midface fractures. Tables list the Glasgow Coma Scale, clinical decision aids for computed tomography after mild TBI, the PECARN clinical decision rule for children with mild TBI, the graduated return to play protocol, and anticoagulant and antiplatelet agent reversal. This review contains 8 highly rendered figures, 5 tables, and 75 references.

Trauma: Head and Facial Trauma

2015 ◽  
Author(s):  
Christopher R. Tainter ◽  
Raghu Seethala
Keyword(s):  
Decision Aids ◽  
Head Injuries ◽  
Antiplatelet Agent ◽  
Clinical Decision ◽  
Return To Play ◽  
Facial Trauma ◽  
Left Frontal Lobe ◽  
Mild Tbi ◽  
Computed Tomographic ◽  
Le Fort Classification

Head and facial trauma includes a wide variety of heterogeneous injuries that vary according to cause, severity, management, and outcomes. These injuries are classified as head injuries (the scalp, skull, and brain) and facial injuries (to the eyes, bony structures, nose, mouth, teeth, tongue, and glands and the accompanying nerves, muscles, and vasculature). This review covers the epidemiology, anatomy, assessment and stabilization, diagnosis, treatment and disposition, and outcomes for traumatic brain injury (TBI), scalp and cranial vault trauma, ocular trauma, and facial trauma. Figures show computed tomographic scans showing a large left frontal lobe intraparenchymal hemorrhage, a traumatic subarachnoid hemorrhage, a subdural hematoma, a right occipital epidural hematoma, and a left orbital floor “blowout” fracture; an illustration of the brain herniation syndromes; the anatomy of the globe; and the Le Fort classification scheme of midface fractures. Tables list the Glasgow Coma Scale, clinical decision aids for computed tomography after mild TBI, the PECARN clinical decision rule for children with mild TBI, the graduated return to play protocol, and anticoagulant and antiplatelet agent reversal. This review contains 8 highly rendered figures, 5 tables, and 75 references.

scholarly journals Padded Headgear does not Reduce the Incidence of Match Concussions in Professional Men’s Rugby Union: A Case-control Study of 417 Cases

2021 ◽  
Author(s):  
Keith A. Stokes ◽  
Matthew Cross ◽  
Sean Williams ◽  
Carly McKay ◽  
Brent E. Hagel ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Head Injuries ◽  
Median Number ◽  
Case Control ◽  
Rugby Union ◽  
Return To Play ◽  
Injury Incidence ◽  
Video Footage ◽  
Four Seasons ◽  
Nested Case Control

AbstractConcussion is the most common match injury in rugby union. Some players wear padded headgear, but whether this protects against concussion is unclear. In professional male rugby union players, we examined: (i) the association between the use of headgear and match concussion injury incidence, and (ii) whether wearing headgear influenced time to return to play following concussion. Using a nested case-control within a cohort study, four seasons (2013–2017) of injury data from 1117 players at the highest level of rugby union in England were included. Cases were physician-diagnosed concussion injuries. Controls were other contact injuries (excluding all head injuries). We determined headgear use by viewing video footage. Sixteen percent of cases and controls wore headgear. Headgear use had no significant effect on concussion injury incidence (adjusted odds ratio=1.05, 95% CI: 0.71–1.56). Median number of days absent for concussion whilst wearing headgear was 8 days, compared with 7 days without headgear. Having sustained a concussion in the current or previous season increased the odds of concussion more than four-fold (odds ratio=4.55, 95% CI: 3.77–5.49). Wearing headgear was not associated with lower odds of concussions or a reduced number of days' absence following a concussion.

scholarly journals 31 Head home: a prospective cohort study of a nurse led paediatric head injury clinical decision tool at a district general hospital

2020 ◽  
Vol 37 (12) ◽  
pp. 853-854
Author(s):  
Patrick Aldridge ◽  
Heather Castle ◽  
Emma Russell ◽  
Clare Phillips ◽  
Richard Guerrero-Luduena ◽  
...  
Keyword(s):  
Head Injury ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Head Injuries ◽  
Clinical Decision ◽  
Decision Tool ◽  
Intracranial Injury ◽  
Multi Centre Study ◽  
Paediatric Head Injury ◽  
Published Evidence

Aims/Objectives/BackgroundObjectivesTo assess if application of a nurse-led paediatric head injury clinical decision tool would be safe compared to current practice.Background>700,000 children attend UK hospitals’ each year with a head injury. Research indicates <1% undergo neurosurgical intervention. No published evidence for nurse-led discharge of paediatric head injuries exists.Methods/DesignMethods – All paediatric (<17 years) patients with head injuries presenting to our Emergency department (ED) 1st May to 31st October 2018 were prospectively screened by a nurse using a mandated electronic ‘Head Injury Discharge At Triage’ questionnaire (HIDATq). We determined which patients underwent computed tomography (CT) brain and whether there was a clinically important intracranial injury or re-presentation to ED. The negative predictive value of the screening tool was assessed. We determined what proportion of patients could have been sent home from triage using HIDATq.Results/ConclusionsResults - Of 1739 patients screened; 61 had CTs performed due to head injury (6 abnormal) with a CT rate of 3.5% and 2% re-presentations. Of the entire cohort, 1052 screened negative. 1 CT occurred in this group showing no abnormalities. Of those screened negative: 349/1052 (33%) had ‘no other injuries’ and 543/1052 (52%) had ‘abrasions or lacerations’. HIDATq’s negative predictive value for CT was 99.9% (95% Confidence interval (CI) 99.4–99.9%) and 100% (CI 99.0–100%) for intracranial injury. The positive predictive value of the tool was low. Five patients screened negative and re-presented within 72hrs but did not require CT imaging.Conclusion - A negative HIDATq appears safe in our ED. Potentially 20% (349/1739) of all patients with head injuries presenting to our department could be discharged by nurses at triage with adequate safety netting advice. This increases to 50% (543/1739) if patients with lacerations or abrasions were treated and discharged at triage. A large multi-centre study is required to validate the tool.

Complete Temporal Lobectomy for Surgical Resuscitation of Patients with Transtentorial Herniation Secondary to Unilateral Hemispheric Swelling

Neurosurgery ◽  
1991 ◽  
Vol 29 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Eric S. Nussbaum ◽  
Aizik L. Wolf ◽  
Leslie Sebring ◽  
Stuart Mirvis
Keyword(s):  
Daily Living ◽  
Clinical Evidence ◽  
Head Injuries ◽  
Clinical Signs ◽  
Temporal Lobectomy ◽  
Midline Shift ◽  
Single Patient ◽  
Transtentorial Herniation ◽  
Computed Tomographic ◽  
Scale Scores

Abstract Transtentorial herniation is an ominous finding in the patient with head injuries. We report our experience with 10 patients suffering from acute transtentorial herniation secondary to posttraumatic unilateral hemispheric swelling who were treated aggressively with temporal lobectomy. Eight patients were men and 2 were women. Their ages ranged from 22 to 61 years, with a mean of 37 years. Their preoperative Glasgow Coma Scale scores ranged from 3 to 6, with a mean of 4. All patients had both computed tomographic and clinical evidence of unilateral hemispheric shift and acute herniation without a significant subdural or epidural hematoma. Seven patients had unilateral nonreactive pupils and 3 had bilateral nonreactive pupils. All were taken to the operating room within 2 hours of clinical signs of herniation. Complete unilateral temporal lobectomies including the mesial structures, amygdala, and uncus were performed. In this series, the mortality rate was 30%, including a single patient who was neurologically stable but died from nonneurological injuries. Of the 7 survivors, 4 were functionally independent and 3 required minimal assistance with the activities of daily living. Aggressive, early decompression via complete temporal lobectomy may thus significantly improve the outcome in patients with transtentorial herniation accompanying posttraumatic hemispheric swelling and midline shift. (Neurosurgery 29:62-66, 1991)

Assessment of Mild Head Injury Using Measures of Balance and Cognition: A Case Study

1997 ◽  
Vol 6 (3) ◽  
pp. 283-289 ◽  
Author(s):  
Bryan L. Riemann ◽  
Kevin M. Guskiewicz
Keyword(s):  
Head Injury ◽  
Sports Medicine ◽  
Athletic Trainers ◽  
Head Injuries ◽  
Football Player ◽  
Athletic Participation ◽  
Return To Play ◽  
Mild Head Injury ◽  
Collegiate Football

Mild head injury (MHI) represents one of the most challenging neurological pathologies occurring during athletic participation. Athletic trainers and sports medicine personnel are often faced with decisions about the severity of head injury and the timing of an athlete's return to play following MHI. Returning an athlete to competition following MHI too early can be a catastrophic mistake. This case study involves a 20-year-old collegiate football player who sustained three mild head injuries during one season. The case study demonstrates how objective measures of balance and cognition can be used when making decisions about returning an athlete to play following MHI. These measures can be used to supplement the subjective guidelines proposed by many physicians.

Long-Term Anesthetic-Dependent Hypoactivity after Repetitive Mild Traumatic Brain Injuries in Adolescent Mice

2016 ◽  
Vol 38 (3) ◽  
pp. 220-238 ◽  
Author(s):  
Bridgette D. Semple ◽  
Raha Sadjadi ◽  
Jaclyn Carlson ◽  
Yiran Chen ◽  
Duan Xu ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Vasogenic Edema ◽  
Head Injuries ◽  
Traumatic Brain Injuries ◽  
Return To Play ◽  
Brain Maturation ◽  
Long Term Outcomes ◽  
Mild Traumatic Brain Injuries

Recent evidence supports the hypothesis that repetitive mild traumatic brain injuries (rmTBIs) culminate in neurological impairments and chronic neurodegeneration, which have wide-ranging implications for patient management and return-to-play decisions for athletes. Adolescents show a high prevalence of sports-related head injuries and may be particularly vulnerable to rmTBIs due to ongoing brain maturation. However, it remains unclear whether rmTBIs, below the threshold for acute neuronal injury or symptomology, influence long-term outcomes. To address this issue, we first defined a very mild injury in adolescent mice (postnatal day 35) as evidenced by an increase in Iba-1- labeled microglia in white matter in the acutely injured brain, in the absence of indices of cell death, axonal injury, and vasogenic edema. Using this level of injury severity and Avertin (2,2,2-tribromoethanol) as the anesthetic, we compared mice subjected to either a single mTBI or 2 rmTBIs, each separated by 48 h. Neurobehavioral assessments were conducted at 1 week and at 1 and 3 months postimpact. Mice subjected to rmTBIs showed transient anxiety and persistent and pronounced hypoactivity compared to sham control mice, alongside normal sensorimotor, cognitive, social, and emotional function. As isoflurane is more commonly used than Avertin in animal models of TBI, we next examined long-term outcomes after rmTBIs in mice that were anesthetized with this agent. However, there was no evidence of abnormal behaviors even with the addition of a third rmTBI. To determine whether isoflurane may be neuroprotective, we compared the acute pathology after a single mTBI in mice anesthetized with either Avertin or isoflurane. Pathological findings were more pronounced in the group exposed to Avertin compared to the isoflurane group. These collective findings reveal distinct behavioral phenotypes (transient anxiety and prolonged hypoactivity) that emerge in response to rmTBIs. Our findings further suggest that selected anesthetics may confer early neuroprotection after rmTBIs, and as such mask long-term abnormal phenotypes that may otherwise emerge as a consequence of acute pathogenesis.

Complete resolution of a hamstring intramuscular tendon injury on MRI is not necessary for a clinically successful return to play

2020 ◽  
pp. bjsports-2019-101808 ◽  
Author(s):  
Robin Vermeulen ◽  
Emad Almusa ◽  
Stan Buckens ◽  
Willem Six ◽  
Rod Whiteley ◽  
...  
Keyword(s):  
Decision Making ◽  
Sports Medicine ◽  
Complete Resolution ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Tendon Injury ◽  
Tendon Injuries ◽  
Return To Play ◽  
Partial Thickness ◽  
Mri Characteristics

BackgroundClinical decision-making around intramuscular tendon injuries of the hamstrings is a controversial topic in sports medicine. For this injury, MRI at return to play (RTP) might improve RTP decision-making; however, no studies have investigated this.ObjectiveOur objectives were to describe MRI characteristics at RTP, to evaluate healing and to examine the association of MRI characteristics at RTP with reinjury for clinically recovered hamstring intramuscular tendon injuries.MethodsWe included 41 athletes with hamstring intramuscular tendon injuries and an MRI at baseline and RTP. For both MRIs, we used a standardised scoring form that included intramuscular tendon injury characteristics. We recorded reinjuries during 1-year follow-up.ResultsAt RTP, 56% of the intramuscular tendons showed a partial or complete thickness tendon discontinuity. Regarding healing from injury to RTP, 18 of 34 (44% overall) partial-thickness tendon discontinuities became continuous and 6 out of 7 (15% overall) complete thickness tendon discontinuities became partial-thickness tendon discontinuities. Waviness decreased from 61% to 12%, and 88% of tendons became thickened. We recorded eight (20%) reinjuries within 1 year. Intramuscular tendon characteristics at RTP between participants with or without a reinjury were similar.ConclusionComplete resolution of an intramuscular tendon injury on MRI is not necessary for clinically successful RTP. From injury to RTP, the intramuscular tendon displayed signs of healing. Intramuscular tendon characteristics of those with or without a reinjury were similar.

scholarly journals Concussion in Hockey: Compliance with Return to Play Advice and Follow-up Status

2009 ◽  
Vol 36 (2) ◽  
pp. 207-212 ◽  
Author(s):  
Alun Ackery ◽  
Christine Provvidenza ◽  
Charles H. Tutor
Keyword(s):  
Head Injuries ◽  
Compliance Rate ◽  
Retrospective Chart Review ◽  
Participation Rate ◽  
Clinic Visit ◽  
Return To Play ◽  
Hockey Players ◽  
Professional Aspirations

Objectives:To determine the compliance rate among hockey players with concussion or other head injuries who were advised by a physician about return to play. To assess compliance of hockey players with return to play advice and to assess the incidence of long-term post-concussion symptoms.Methods:A retrospective chart review, telephone questionnaire and follow-up analysis of income, level of education and professional aspirations. The study examined 40 hockey players with concussion or other head injury treated at a neurosurgical ambulatory clinic, who had initial visits between 1995 and 2003, and had been seen at least two years prior to completing the questionnaire.Results:There was a 58% (23 of 40) participation rate in the study. Fifteen (65%) of the 23 participants were advised to never return to play, and 5 (33%) were non-compliant and returned to play. Four (80%) of the five non-compliant players continued to suffer from post concussion symptoms. Overall, 15 (65%) of the 23 players participating in the study continued to suffer post concussion symptoms at least two years after the clinic visit.Conclusions:Five (33%) of 15 hockey players advised to never return to play were non-compliant and returned to play, and four continued to suffer from post concussion symptoms two or more years later. After repeated concussions, 65% of hockey players had long-term sequelae that prevented return to play and produced long-term post-concussion symptoms.

scholarly journals Prevalence of Concussion in Quidditch

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S21.1-S21
Author(s):  
Michael Pepper ◽  
Jeff Wayland ◽  
Adam Elwood ◽  
Spencer Walser ◽  
Vi Tran ◽  
...  
Keyword(s):  
Head Injury ◽  
Health Effects ◽  
Head Injuries ◽  
Return To Play ◽  
Long Term Effects ◽  
Basic Care ◽  
Significant Burden ◽  
Traditional Sports ◽  
Repetitive Injury

ObjectiveThe aim of our study is to assess the rate of concussion occurring while engaging in nontraditional sports such as Quidditch, and the effects that injury during a novelty sport may have on concussion detection when compared to more traditional sports.BackgroundConcussions, once dismissed as nonconsequential, are rapidly attracting notice for acute and long-term health effects. Rates of recovery with repeated trauma is known to decrease with each occurrence. In novelty sports, regulation of concussions and proper return-to-play(RTP) protocol are not routinely enforced, resulting in repetitive injury to the detriment of players.Design/MethodsIRB approval was obtained prior to survey distribution to all players associated with Major League Quidditch (MLQ). Responses were recorded and analyzed.Results157 responses were received. 63% were male and 37% female with mean age 22.9. 146 (93%) respondents confirmed or denied quidditch-related head injury. 22 (15%) denied head injury and 124 (85%) indicated hitting their heads while participating in the sport. 19% of respondents indicated >10 head injuries. 67 (54%) reported suspected concussion with an additional 41 (33%) reporting formal diagnosis with at least one concussion. EMS reported 18 injuries at MLQ matches. 5 (27.8%) were preliminarily diagnosed with concussion. 3 had no further treatment, 1 RTP and 1 received basic care. 0 recieved formal neurologic evaluation. Players were also asked about head injuries sustained in non-quidditch activities for comparison. 43 (27%) reported having medically diagnosed concussions outside of quidditch. 53 (34%) reported at least one suspected concussion without formal diagnosis. 24 (15%) answered maybe.ConclusionsOur data supports that concussion is a significant burden in novelty sports such as quidditch. It is vital to recognize that with the rise of nontraditional sports, the prevalence of concussions in younger nontraditional athletes may be underreported and that concussion specialists must be cognizant of both traditional and novelty sports when evaluating long term effects of head trauma.

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