scholarly journals Head Injuries, A Forensic Overview

2010 ◽  
Vol 23 (1) ◽  
pp. 98-102
Author(s):  
M Emdadur Rahman ◽  
M Enamul Haque ◽  
Md Monsur Rahman
Keyword(s):  
Head Injury ◽  
High Velocity ◽  
Head Injuries ◽  
Point Of View ◽  
Direct Relation ◽  
Blunt Force ◽  
Severity Of Injury ◽  
Direct Violence ◽  
Skull Bones

The incidence of head injuries is growing with greater mechanization in industry and an increase in high velocity transport. The injuries could be caused by a penetrating or blunt force either by direct violence or indirectly, such as a fall on the feet or buttocks. There is no direct relation to the severity of injury to skull bones and extent of cerebral disorder.We is reporting two cases of head injury from forensic point of view. TAJ 2010; 23(1): 98-102

A prospective study of children with head injuries: II. Cognitive sequelae

1981 ◽  
Vol 11 (1) ◽  
pp. 49-61 ◽  
Author(s):  
Oliver Chadwick ◽  
Michael Rutter ◽  
Gillian Brown ◽  
David Shaffer ◽  
Michael Traub
Keyword(s):  
Head Injury ◽  
Prospective Study ◽  
Reading Ability ◽  
Head Injuries ◽  
Specific Pattern ◽  
Control Group ◽  
Severe Injuries ◽  
Injury Group ◽  
Severity Of Injury ◽  
Cognitive Sequelae

SYNOPSISA 2¼-year prospective study of children suffering head injury is described. Three groups of children were studied: (a) 31 children with ‘severe’ head injuries resulting in a post-traumatic amnesia (PTA) of at least 7 days; (b) an individually matched control group of 28 children with hospital treated orthopaedic injuries; and (c) 29 children with ‘mild’ head injuries resulting in a PTA exceeding 1 hour but less than 1 week. Individual psychological testing was carried out as soon as the child recovered from PTA, and then again 4 months, 1 year, and 2¼ years after the injury. A shortened version of the Wechsler Intelligence Scale for Children (WISC), the Neale Analysis of Reading Ability and a battery of tests of specific cognitive functions were employed. The mild head injury group had a mean level of cognitive functioning below the control group, but the lack of any recovery during the follow-up period indicated that the intellectual impairment was not a consequence of the injury. In the severe head injury group, the presence of cognitive recovery and a ‘dose—response’ relationship with the degree of brain injury showed that the intellectual deficits were caused by brain damage. Some degree of cognitive impairment was common following head injuries giving rise to a PTA of at least 2 weeks. Conversely no cognitive sequelae, transient or persistent, could be detected when the PTA was less than 24 hours. The results were less consistent in the 1-day to 2-week PTA range, but the evidence suggested that a broadly defined threshold for impairment operated at about that level of severity of injury. Timed measures of visuo-spatial and visuo-motor skills tended to show more impairment than verbal skills but otherwise there was no suggestion of a specific pattern of cognitive deficit. Recovery was most rapid in the early months after injury, but substantial recovery continued for 1 year with some improvement continuing in the second year in some children, especially those with the most severe injuries. Age, sex and social class showed no significant effects on the course of recovery.

scholarly journals Outcome of Head Injury Patients Undergoing Surgical Management: A Tertiary Level Experience

2012 ◽  
Vol 9 (4) ◽  
pp. 283-285
Author(s):  
A Shrestha ◽  
R M Joshi ◽  
A Thapa ◽  
U P Devkota ◽  
D N Gongal
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Surgical Intervention ◽  
Head Injuries ◽  
Glasgow Outcome Score ◽  
Injury Mortality ◽  
Outcome Score ◽  
Injury Group ◽  
Neurosurgical Patient ◽  
Severity Of Injury

Background Head injury is the major cause of death in a neurosurgical patient. Objective To find the outcome, and treatment modality affecting the outcome in patients with head injury. Methods Nine hundred eighty seven patients presenting to National Institute of Neurological and Allied Sciences, Kathmandu, with head injury from September 2009 to October 2010 were included in the study. Patients were categorized according to post resuscitation Glasgow Coma Score. Outcome was assessed at discharge using Glasgow Outcome Score and analyzed for any correlation with modality of treatment and severity of injury. Results Among 987 patients with head injury,152 (15.4%) had severe, 126 (12.8%) had moderate and 709 (71.8%) had mild head injuries. Three hundred twelve (31.6%) patients required definitive and supportive surgical intervention. One hundred eighty two required cranial surgical intervention. Overall mortality was 10% (99), 137 patients (13.9%) had unfavorable outcome and 850 (86.1%) had favorable Glasgow Outcome Score of 4 and 5. Mortality was 53.2%, 9.5% and 0.8% in severe, moderate and mild head injury group respectively. Mortality rate was significantly higher (64.6%) in severe head injury group managed conservatively than those in same group treated with supportive and definite surgical intervention (44.8%) (p=0.016). Conclusion Mortality in head injury patients depend upon severity of injury. Mortality in severe head injury group can be reduced by supportive and definite surgical intervention.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6345 Kathmandu Univ Med J 2011;9(4):283-5

Cause of decline in head-injury mortality rate in San Diego County, California

1985 ◽  
Vol 62 (4) ◽  
pp. 528-531 ◽  
Author(s):  
Melville R. Klauber ◽  
Lawrence F. Marshall ◽  
Belinda M. Toole ◽  
Sharen L. Knowlton ◽  
Sharon A. Bowers
Keyword(s):  
Head Injury ◽  
San Diego ◽  
Head Injuries ◽  
Mortality Rates ◽  
San Diego County ◽  
Content Type ◽  
Severity Of Injury ◽  
Prehospital Emergency ◽  
Injured Patients ◽  
Number Of Individuals

✓ Even with an increasing population, there were 100 fewer deaths due to head injury in San Diego County, California, in 1982 compared to 1980. During the 5 years from 1976 to 1980 there was nearly a constant death rate from head injuries, followed in the next 2 years by a decline of 24%. The number of deaths at the scene of injury declined 28%, and the number of individuals listed as dead on arrival at the hospital declined 68%. Mortality rates in the emergency room increased slightly and later death rates declined slightly. Mortality rates of hospitalized patients, adjusted for severity of injury, did not vary materially by year. This decline in deaths due to head injury followed a marked improvement in the county's emergency ground and prehospital air evacuation services. The data strongly suggest that advanced prehospital emergency medical services can substantially reduce mortality rates in head-injured patients. The authors postulate that some patients who ordinarily “would die now talk” because of early airway and circulatory management by highly trained paramedical personnel and airborne trauma specialists. Despite a search for other factors that might explain these observations, no satisfactory alternatives could be identified.

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.

Moderate Head Injury: Completing the Clinical Spectrum of Brain Trauma

Neurosurgery ◽  
1982 ◽  
Vol 11 (3) ◽  
pp. 344-351 ◽  
Author(s):  
Rebecca W. Rimel ◽  
Bruno Giordani ◽  
Jeffrey T. Barth ◽  
John A. Jane
Keyword(s):  
Head Injury ◽  
Present Report ◽  
Economic Status ◽  
Head Injuries ◽  
Ct Scanning ◽  
Minor Head Injury ◽  
Good Recovery ◽  
Severe Injuries ◽  
Computed Tomographic ◽  
Severity Of Injury

Abstract We have divided head injury into three categories based on the Glasgow Coma Scale (GCS) (severe, 3–8; moderate, 9–12; and minor, 13–15). In a previous report, we described significant disability after minor head injury. The present report describes 199 patients with moderate head injury, 159 of whom underwent follow–up examinations at 3 months. In contrast to patients with minor head injury, half as many were students (17%) and twice as many were intoxicated (53%). Seventy–five patients were studied with computed tomographic (CT) scanning; 30% of the scans were negative and 31% showed a space–occupying mass. As reported by Gennarelli et al. in patients with severe head injuries, those with moderate head injury and subdural hematoma had a very poor outcome: 65% died or were severely disabled and none made a good recovery as measured by the Glasgow Outcome Scale. At 3 months, 38% of the moderate head injury patients had made a good recovery compared with 75% of the minor head injury patients. Within the good recovery category, however, there was much disability (headache, 93%; memory difficulties, 90% difficulties with activities of daily living, 87%), and only 7% of the patients were asymptomatic. The Halstead–Reitan Neuropsychological Battery in an unselected subset (n = 32) showed significant deficits on all test measures. Sixty–six per cent of the patients previously employed had not returned to work, compared to 33% of the minor head injury patients. The major predictors of unemployment after minor head injury were premorbid characteristics (age, education, and socio–economic status). In contrast, all predictors in moderate head injury were measures of the severity of injury (length of coma, CT diagnosis. GCS on discharge). We conclude that: (a) moderate head injury, not described previously in the literature, results in mortality and substantial morbidity intermediate between those of severe and minor head injury; (b) unlike minor head injury, the principal predictors of outcome after moderate head injury are measures of the severity of injury; and (c) more attention should be directed to patients with moderate head injury than to those with the most severe injuries, in whom brain damage is probably irreversible and all forms of management have demonstrated little success.

Facial Fractures: Associated Injuries and Complications

1993 ◽  
Vol 1 (4) ◽  
pp. 160-165
Author(s):  
J Grant Thomson ◽  
Harvey C Brown ◽  
Rea A Brown ◽  
David M Fleiszer
Keyword(s):  
Head Injury ◽  
High Velocity ◽  
Mechanism Of Injury ◽  
Associated Injuries ◽  
Seat Belts ◽  
Facial Fractures ◽  
Facial Fracture ◽  
Low Velocity ◽  
Severity Of Injury ◽  
Trauma Score

JG Thomson, HC Brown, RA Brown, DM Fleiszer. Facial fractures: Associated injuries and complications. Can J Plast Surg 1994;1(4):160-165. The forces necessary to produce a facial fracture are often high enough to cause other severe, life-threatening injuries. Despite this knowledge, little is known about the frequency or nature of these injuries. A retrospective chart review was performed on 162 facial fracture patients for associated injuries and complications. These patients were divided into high velocity (n=95) and low-velocity (n=67) groups based on the mechanism of injury, and were compared with a group of 346 multiple trauma patients who did not sustain any facial fracture. Those patients involved in high-velocity accidents had a significantly higher proportion of multiple facial fractures (40%), presence of associated injury (84%), complication rate (38%), mortality rate (9.5%), mean hospital stay (45 days), and mean trauma score (20.1±1.3) when compared with patients in low-velocity accidents (10%, 12%, 10%, 4.3 days and 4.7±0.6, respectively). Although high-G facial bone fractures were more frequent in high-velocity accidents, high-G fractures were not an independent indicator of the severity of injury as measured by the trauma score. The most significant indicator of severity of injury was the mechanism of injury. Pulmonary (15%), cerebral (11 %), septic (7%), abdominal (7%) and cardiac (2%) complications after high-velocity injuries were more frequent than previously reported. Although cervical spine injury has traditionally been associated with facial fractures, the results of this study demonstrated that spinal injury can occur at any vertebral level, and was equal in frequency in patients with and without facial fractures. Statistical analysis of occupant restraint revealed that there was no significant difference between the numbers of patients wearing their seat belts (11) and those not using them (12), the proportions with high-G, low-G, or multiple facial fractures, the incidence of head injury or other associated injuries, the trauma score, and the times spent in the surgical intensive care unit and hospital. Although the lack of significance is probably attributable to the low documentation of seat belt use, the question of the efficacy of seat belts in preventing facial fractures and associated injuries is raised. Patients with facial fractures had a significantly higher mean trauma score (27.9±1.4) and incidence of head injury (54%) compared with patients without facial fractures (23.2±0.7 and 11%, respectively). The surgical treatment of this group of facial fracture patients was analyzed.

scholarly journals Relationship between injury severity, random blood glucose and management outcome in a cohort of Nigerian patients with head injury

2015 ◽  
Vol 6 (02) ◽  
pp. 216-220 ◽  
Author(s):  
Augustine A Adeolu ◽  
T B Rabiu ◽  
O I Orhorhoro ◽  
A O Malomo ◽  
M T Shokunbi
Keyword(s):  
Blood Glucose ◽  
Head Injury ◽  
Injury Severity ◽  
Head Injuries ◽  
Serum Glucose ◽  
Favourable Outcome ◽  
P Value ◽  
Random Blood Glucose ◽  
Severity Of Injury ◽  
Level Of Significance

ABSTRACT Objective: This study was designed to evaluate the relationship between injury severity, admission Random Blood Glucose [RBG] and management outcome in a cohort of Nigerian patients with Head Injury [HI]. Materials and Methods: RBG was determined at admission, twenty four hours as well as seventy two hours after admission in patients with head injury. Severity of injury was graded using Glasgow Coma Scale (GCS). Outcome of management was determined by Glasgow Outcome Score at discharge. Serum glucose level of ≥ 11.1 mmol/l was taken as hyperglycaemia. Analyses of variance [ANOVA] was used to determine level of significance and a P value of < 0.05 was considered significant. Results: There were 146 male and 30 female patients (range: 2 years to 78 years; mean; 34.4 years, SD: 16.4 years). Most (36.4%) of the patients had severe HI. Only 2.5% of the patients had hyperglycaemia at admission. Death occurred in 25% of the patients, moderate disability occurred in 30.1% and good outcome occurred in 35.8%. Hyperglycaemia occurred in one patient each in mild and severe head injuries and in two patients with moderate head injury. All the patients with hyperglycaemia had favourable outcome. Conclusion: Random blood glucose of ≥ 11.1 mmol/l was not common at admission in head injured patients in this cohort of patients and the value was not associated with severe injury or poor outcome.

Head injury mortality in two centers with different emergency medical services and intensive care

1989 ◽  
Vol 71 (2) ◽  
pp. 202-207 ◽  
Author(s):  
Austin R. T. Colohan ◽  
Wayne M. Alves ◽  
Cynthia R. Gross ◽  
James C. Torner ◽  
V. S. Mehta ◽  
...  
Keyword(s):  
Head Injury ◽  
Mortality Rate ◽  
Head Injuries ◽  
Mortality Rates ◽  
Striking Similarity ◽  
Prehospital Emergency Care ◽  
New Delhi ◽  
Severe Injuries ◽  
Content Type ◽  
Severity Of Injury

✓ The authors report data collected prospectively on 551 cases of head injury in New Delhi, India, and 822 cases in Charlottesville, Virginia. The mortality rate, adjusted for initial severity of injury, was 11.0% in New Delhi versus 7.2% in Charlottesville (p < 0.02). There was a striking similarity in mortality rates at both centers when comparing patients with the least severe head injuries and those with the most severe injuries according to the motor score of the Glasgow Coma Scale (GCS M). However, in the group with an abnormal but purposeful motor response (GCS M = 5), the mortality rate was 12.5% in New Delhi versus 4.8% in Charlottesville (p < 0.01). The relative absence of prehospital emergency care and the delay in admission after head injury in New Delhi are cited as two possible causes for the differences in mortality rates in this subgroup of patients with “moderate” head injuries.

scholarly journals Epidemiology and Treatment Outcomes of Head Injury in Bangladesh: Perspective from the Largest Tertiary Care Hospital

2021 ◽  
Author(s):  
Sukriti Das ◽  
Bipin Chaurasia ◽  
Dipankar Ghosh ◽  
Asit Chandra Sarker
Keyword(s):  
Head Injury ◽  
Road Traffic ◽  
Head Injuries ◽  
Skull Fracture ◽  
Tertiary Care ◽  
Acute Subdural Hematoma ◽  
Care Hospital ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
The Government

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

scholarly journals Emergency Department Visits From 2014 to 2018 for Head Injuries in Youth Non-Tackle Football Compared With Other Sports

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097540
Author(s):  
Jessica M. Zendler ◽  
Ron Jadischke ◽  
Jared Frantz ◽  
Steve Hall ◽  
Grant C. Goulet
Keyword(s):  
United States ◽  
Emergency Department ◽  
Head Injury ◽  
Head Injuries ◽  
The United States ◽  
Emergency Department Visits ◽  
Head Region ◽  
Cerebral Contusion ◽  
Common Diagnosis ◽  
Tackle Football

Background: Non-tackle football (ie, flag, touch, 7v7) is purported to be a lower-risk alternative to tackle football, particularly in terms of head injuries. However, data on head injuries in non-tackle football are sparse, particularly among youth participants. Purpose: To describe the epidemiology of  emergency department visits for head injuries due to non-tackle football among youth players in the United States and compare the data with basketball, soccer, and tackle football. Study Design: Descriptive epidemiology study. Methods: Injury data from 2014 to 2018 were obtained from the National Electronic Injury Surveillance System database. Injury reports coded for patients aged 6 to 18 years and associated with basketball, football, or soccer were extracted. Data were filtered to include only injuries to the head region, specifically, the head, ear, eyeball, mouth, or face. Football injuries were manually assigned to “non-tackle” or “tackle” based on the injury narratives. Sports & Fitness Industry Association data were used to estimate annual sport participation and calculate annual injury rates per 100,000 participant-years. Results: A total of 26,770 incident reports from 2014 to 2018 were analyzed. For head region injuries in non-tackle football, the head was the most commonly injured body part, followed by the face; the most common diagnosis was a laceration, followed by concussion and internal injury (defined as an unspecified head injury or internal head injury [eg, subdural hematoma or cerebral contusion]). The most common contacting object was another player. The projected national rate of head region injuries was lowest for non-tackle football across the 4 sports. In particular, the projected rate of injuries to the head for non-tackle football (78.0 per 100,000 participant-years) was less than one-fourth the rates for basketball (323.5 per 100,000 participant-years) and soccer (318.2 per 100,000 participant-years) and less than one-tenth the rate for tackle football (1478.6 per 100,000 participant-years). Conclusion: Among youth in the United States aged 6 to 18 years who were treated in the emergency department for injuries related to playing non-tackle football, the most common diagnosis for injuries to the head region was a laceration, followed by a concussion. Head region injuries associated with non-tackle football occurred at a notably lower rate than basketball, soccer, or tackle football.

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