scholarly journals Factors Affecting Death and Severe Injury in Child Motor Vehicle Passengers

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1431
Author(s):  
Wataru Ishii ◽  
Masahito Hitosugi ◽  
Mineko Baba ◽  
Kenji Kandori ◽  
Yusuke Arai
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Motor Vehicle ◽  
Fatal Outcome ◽  
Multivariate Logistic Regression Analysis ◽  
Severe Injury ◽  
Factors Affecting ◽  
Coma Scale ◽  
Physiological Variables

Saving children from motor vehicle collisions is a high priority because the injury rate among motor vehicle passengers has been increasing in Japan. This study aimed to examine the factors that influence death and serious injury in child motor vehicle passengers to establish effective preventive measures. To identify these factors, we performed a retrospective study using a nationwide medical database. The data of child motor vehicle passengers younger than 15 years (n = 1084) were obtained from the Japanese Trauma Data Bank, registered from 2004 to 2019. Physiological variables, outcomes, and injury severity were compared between fatal and non-fatal patients and between those with and without severe injuries. Multivariate logistic regression analysis was performed to determine factors affecting fatality and severe injury. The Glasgow Coma Scale score (odds ratio (OR): 1.964), body temperature (OR: 2.578), and the Abbreviated Injury Scale score of the head (OR: 0.287) were identified as independent predictors of a non-fatal outcome. Systolic blood pressure (OR: 1.012), the Glasgow Coma Scale score (OR: 0.705), and Focused Assessment with Sonography for Trauma positivity (OR: 3.236) were identified as independent predictors of having severe injury. Decreasing the severity of head injury is the highest priority for child motor vehicle passengers to prevent fatality and severe injury.

Retroclival Epidural Hematomas

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 404-407 ◽  
Author(s):  
R. Shane Tubbs ◽  
Christoph J. Griessenauer ◽  
Todd Hankinson ◽  
Curtis Rozzelle ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Pediatric Patients ◽  
Motor Vehicle ◽  
Coma Scale ◽  
Presenting Symptoms ◽  
Cord Injury ◽  
The Mean

Abstract BACKGROUND Retroclival epidural hematomas (REDHs) are infrequently reported. To our knowledge, only 19 case reports exist in the literature. OBJECTIVE This study was performed to better elucidate this pathology. METHODS We prospectively collected data for all pediatric patients diagnosed with REDH from July 2006 through June 2009. Data included mechanism of injury, Glasgow Coma Scale score, neurological examination, treatment modality, and outcome. Magnetic resonance imaging was used to measure REDH dimensions. RESULTS Eight children were diagnosed with REDH, and the hematomas were secondary to motor vehicle–related trauma in all cases. The mean age of patients was 12 years (range 4–17 years). The mean REDH height (craniocaudal) was 4.0 cm, and the mean thickness (dorsoventral) was 1.0 cm. At presentation, the mean Glasgow Coma Scale score was 8 (range 3–14), and there was no correlation between hematoma size and presenting symptoms. Two patients died soon after injury, and 2 additional patients had atlanto-occipital dislocation that required surgical intervention. No patient underwent surgical evacuation of the REDH. The mean follow-up was 14 months. At most recent follow-up, 4 patients are neurologically intact, 1 patient has a complete spinal cord injury, and 1 patient has mild bilateral abducens nerve palsy. CONCLUSION To our knowledge, this study of 8 pediatric patients is the largest series of patients with REDH thus far reported. Based on our study, we found that REDH is likely to be underdiagnosed, atlanto-occipital dislocation should be considered in all cases of REDH, and many patients with REDH will have minimal long-term neurological injury.

Intraventricular hemorrhage on computed tomography and corpus callosum injury on magnetic resonance imaging in patients with isolated blunt traumatic brain injury

2012 ◽  
Vol 117 (2) ◽  
pp. 334-339 ◽  
Author(s):  
Hidetoshi Matsukawa ◽  
Masaki Shinoda ◽  
Motoharu Fujii ◽  
Osamu Takahashi ◽  
Atsushi Murakata ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Regression Analysis ◽  
Brain Injury ◽  
Corpus Callosum ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Intraventricular Hemorrhage ◽  
Multivariate Logistic Regression Analysis ◽  
Coma Scale

Object Intraventricular hemorrhage (IVH) is widely regarded as one element of a complex involving severe blunt traumatic brain injury (TBI); corpus callosum injury (CCI) is recently considered to be one factor associated with poor outcome in patients with TBI. Although postmortem studies have focused on the relationship between IVH and CCI, there have been few investigations of IVH evidenced on CT scans as a predictor of CCI evidenced on MRI. Methods The authors retrospectively reviewed prospectively collected data from 371 patients with blunt TBI, without trauma to the face, chest, abdomen, extremities, or pelvic girdle, requiring immediate therapeutic intervention. Their aim was to investigate whether IVH found on CT predicts CCI on MRI. Clinical and radiological data were collected between June 2003 and February 2011. First, the authors classified patients into groups of those with CCI and those without CCI, and they compared clinical and radiological findings between them. Then, they investigated prognostic factors that were related to the development of disability at 6 months after injury. The outcomes at 6 months after injury were evaluated using the Extended Glasgow Outcome Scale (GOS-E). Finally, the authors evaluated the correlation between the severity of the IVH on CT and the number of CCI lesions on MRI. The severity of the IVH was defined by the number of ventricles in which IVH was seen, and the number of CCI lesions was counted on the MRI study. Results On multivariate logistic regression analysis, Glasgow Coma Scale score less than 9 (OR 2.70 [95% CI 1.10–6.27]), traffic accident (OR 2.59 [95% CI 1.37–4.93]), and IVH on CT (OR 3.31 [95% CI 1.25–8.49]) were significantly related to CCI. Multivariate analysis also showed that older age (p = 0.0001), male sex (OR 3.26 [95% CI 1.46–8.08], p = 0.0065), Glasgow Coma Scale score less than 9 (OR 8.27 [95% CI 3.39–21.4], p < 0.0001), evidence of IVH on CT (OR 4.09 [95% CI 1.45–11.9], p = 0.0081), and evidence of CCI on MRI (OR 8.32 [95% CI 3.89–18.8], p < 0.0001) were associated with future development of disability (GOS-E score ≤6). Furthermore, simple regression analysis revealed the existence of a strong correlation between the severity of IVH and the number of CCI lesions (r = 0.0668, p = 0.0022). Conclusions The authors' results suggest that evidence of IVH on CT may indicate CCI, which can lead to disability in patients with isolated blunt TBI.

Epidural Hematoma

Neurotrauma ◽  
2019 ◽  
pp. 35-44
Author(s):  
Lydia Kaoutzani ◽  
Martina Stippler
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Epidural Hematoma ◽  
Emergency Situation ◽  
Intracranial Injury ◽  
Coma Scale ◽  
Sagittal Sinus ◽  
Interosseous Artery ◽  
Neurologically Intact

Although epidural hematomas (EDH) are not frequently seen with intracranial injury in trauma, they present an emergency situation that can result in significant mortality if not diagnosed and treated in a timely manner. EDH stems from bleeding from the bone rupturing an interosseous artery, the bone itself, or from a venous sinus laceration. Most EDH present with a classic biconvex shape on CT images. Venous EDH can cross the midline and are often found under the transverse or sagittal sinus. The current school of thought is that patients who present with a small (<10 mm maximal thickness) EDH with no neurological symptoms can be treated conservatively. Patients neurologically intact with a normal Glasgow Coma Scale score but an EDH of greater than 30 cc should undergo surgery.

Comparison of AVPU Scale and the Glasgow Coma Scale Score in Assessing Encephalitis in Children

2016 ◽  
Vol 01 (04) ◽  
Author(s):  
Nguyen Thi Huyen Sam ◽  
Pham Ngoc Toan ◽  
Truong Thi Mai Hong ◽  
Le Thanh Hai
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Coma Scale

Devastating Consequences of Subway Accidents: Traumatic Amputations

2006 ◽  
Vol 72 (1) ◽  
pp. 74-76 ◽  
Author(s):  
Alexandra A. Maclean ◽  
Andrea M. O'Neill ◽  
H. Leon Pachter ◽  
Maurizio A. Miglietta
Keyword(s):  
New York ◽  
Glasgow Coma Scale ◽  
Limb Salvage ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Injury Severity ◽  
Vital Signs ◽  
Wound Infection Rate ◽  
Operative Procedures ◽  
Coma Scale

The efficiencies of the subway system are tempered by the occurrence of accidents, some with devastating injuries. The purpose of this study is to examine our experience with traumatic amputations after subway accidents. A retrospective trauma registry review (1989–2003) of 41 patients who presented to Bellevue Hospital, New York City, with amputations from subway accidents was undertaken to examine the following end points: age, sex, Injury Severity Score, time and mechanism of accident, history of psychiatric disorders and alcohol use, admission vital signs, Glasgow Coma Scale score, amputation type, associated injuries, limb salvage rate, operative procedures, mortality, and disposition. Elevated alcohol levels and prior psychiatric diagnoses were present in 39 per cent and 17 per cent of the patients, respectively. Patients were stable on admission with a mean systolic blood pressure of 114 mmHg, hematocrit of 32, and Glasgow Coma Scale score range of 13 to 15. The most common amputation was below knee, and patients underwent an average of three operative procedures. Limb salvage was attempted in eight patients with no successes. Amputation wound infection rate was 32 per cent and mortality rate was 5 per cent. Victims of subway trauma who arrive at the hospital with devastating amputations have an excellent chance of surviving to discharge.

Blast Injury in a Civilian Trauma Setting is Associated with a Delay in Diagnosis of Traumatic Brain Injury

2008 ◽  
Vol 74 (3) ◽  
pp. 267-270 ◽  
Author(s):  
Grant V. Bochicchio ◽  
Kimberly Lumpkins ◽  
James O'Connor ◽  
Marc Simard ◽  
Stacey Schaub ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Injury Severity ◽  
Disease Process ◽  
Blast Injury ◽  
Coma Scale ◽  
The Mean

High-pressure waves (blast) account for the majority of combat injuries and are becoming increasingly common in terrorist attacks. To our knowledge, there are no data evaluating the epidemiology of blast injury in a domestic nonterrorist setting. Data were analyzed retrospectively on patients admitted with any type of blast injury over a 10-year period at a busy urban trauma center. Injuries were classified by etiology of explosion and anatomical location. Eighty-nine cases of blast injury were identified in 57,392 patients (0.2%) treated over the study period. The majority of patients were male (78%) with a mean age of 40 ± 17 years. The mean Injury Severity Score was 13 ± 11 with an admission Trauma and Injury Severity Score of 0.9 ± 0.2 and Revised Trauma Score of 7.5 ± 0.8. The mean intensive care unit and hospital length of stay was 2 ± 7 days and 4.6 ± 10 days, respectively, with an overall mortality rate of 4.5 per cent. Private dwelling explosion [n = 31 (35%)] was the most common etiology followed by industrial pressure blast [n = 20 (22%)], industrial gas explosion [n = 16 (18%)], military training-related explosion [n = 15 (17%)], home explosive device [n = 8 (9%)], and fireworks explosion [n = 1 (1%)]. Maxillofacial injuries were the most common injury (n = 78) followed by upper extremity orthopedic (n = 29), head injury (n = 32), abdominal (n = 30), lower extremity orthopedic (n = 29), and thoracic (n = 19). The majority of patients with head injury [28 of 32 (88%)] presented with a Glasgow Coma Scale score of 15. CT scans on admission were initially positive for brain injury in 14 of 28 patients (50%). Seven patients (25%) who did not have a CT scan on admission had a CT performed later in their hospital course as a result of mental status change and were positive for traumatic brain injury (TBI). Three patients (11%) had a negative admission CT with a subsequently positive CT for TBI over the next 48 hours. The remaining four patients (14%) were diagnosed with skull fractures. All patients (n = 4) with an admission Glasgow Coma Scale score of less than 8 died from diffuse axonal injury. Blast injury is a complicated disease process, which may evolve over time, particularly with TBI. The missed injury rate for TBI in patients with a Glasgow Coma Scale score of 15 was 36 per cent. More studies are needed in the area of blast injury to better understand this disease process.

Dysfunction of hypothalamic-hypophysial axis after traumatic brain injury in adults

2010 ◽  
Vol 113 (3) ◽  
pp. 581-584 ◽  
Author(s):  
David Krahulik ◽  
Jirina Zapletalova ◽  
Zdenek Frysak ◽  
Miroslav Vaverka
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Clinical Symptoms ◽  
Empty Sella ◽  
Pituitary Hormone ◽  
Endocrine Dysfunction ◽  
Coma Scale

Object Traumatic brain injury (TBI) is a major cause of serious morbidity and mortality. The incidence is 100–500/100,000 inhabitants/year. Chronic pituitary dysfunction is increasingly recognized after TBI. To define the incidence of endocrine dysfunction and risk factors, the authors describe a prospectively assessed group of patients in whom they documented hormonal functions, early diagnosis, and treatment of neuroendocrine dysfunction after TBI. Methods Patients aged 18–65 years were prospectively observed from the time of injury to 1 year postinjury; the Glasgow Coma Scale score ranged from 3 to 14. Patients underwent evaluation of hormonal function at the time of injury and at 3, 6, and 12 months postinjury. Magnetic resonance imaging was also conducted at 1 year postinjury. Results During the study period, 89 patients were observed. The mean age of the patients was 36 years, there were 23 women, and the median Glasgow Coma Scale score was 7. Nineteen patients (21%) had primary hormonal dysfunction. Major deficits included growth hormone dysfunction, hypogonadism, and diabetes insipidus. Patients in whom the deficiency was major had a worse Glasgow Outcome Scale score, and MR imaging demonstrated empty sella syndrome more often than in patients without a deficit. Conclusions To the authors' knowledge, this is the third largest study of its kind worldwide. The incidence of chronic hypopituitarism after TBI was higher than the authors expected. After TBI, patients are usually observed on the neurological and rehabilitative wards, and endocrine dysfunction can be overlooked. This dysfunction can be life threatening and other clinical symptoms can worsen the neurological deficit, extend the duration of physiotherapy, and lead to mental illness. The authors recommend routine pituitary hormone testing after moderate or severe TBI within 6 months and 1 year of injury.

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