scholarly journals Influence of Skull Fracture on Traumatic Brain Injury Risk Induced by Blunt Impact

2020 ◽  
Vol 17 (7) ◽  
pp. 2392 ◽  
Author(s):  
Lihai Ren ◽  
Dangdang Wang ◽  
Xi Liu ◽  
Huili Yu ◽  
Chengyue Jiang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Risk ◽  
Skull Fracture ◽  
Human Model ◽  
Damage Modeling ◽  
Diffuse Brain Injury ◽  
Blunt Impact ◽  
Ground Impact ◽  
Diffuse Brain

This study is aimed at investigating the influence of skull fractures on traumatic brain injury induced by blunt impact via numerous studies of head–ground impacts. First, finite element (FE) damage modeling was implemented in the skull of the Total HUman Model for Safety (THUMS), and the skull fracture prediction performance was validated against a head–ground impact experiment. Then, the original head model of the THUMS was assigned as the control model without skull element damage modeling. Eighteen (18) head–ground impact models were established using these two FE head models, with three head impact locations (frontal, parietal, and occipital regions) and three impact velocities (25, 35, and 45 km/h). The predicted maximum principal strain and cumulative strain damage measure of the brain tissue were employed to evaluate the effect of skull fracture on the cerebral contusion and diffuse brain injury risks, respectively. Simulation results showed that the skull fracture could reduce the risk of diffuse brain injury risk under medium and high velocities significantly, while it could increase the risk of brain contusion under high-impact velocity.

scholarly journals The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury

2021 ◽  
Vol 11 ◽  
Author(s):  
Jelmer-Joost Lenstra ◽  
Lidija Kuznecova-Keppel Hesselink ◽  
Sacha la Bastide-van Gemert ◽  
Bram Jacobs ◽  
Maarten Willem Nicolaas Nijsten ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Cardiac Arrhythmias ◽  
Injury Severity ◽  
Thoracic Injury ◽  
Diffuse Brain Injury ◽  
Severe Tbi ◽  
Ecg Abnormalities ◽  
Diffuse Brain

The aim of this study was to evaluate the frequency of electrocardiographic (ECG) abnormalities in the acute phase of severe traumatic brain injury (TBI) and the association with brain injury severity and outcome. In contrast to neurovascular diseases, sparse information is available on this issue. Data of adult patients with severe TBI admitted to the Intensive Care Unit (ICU) for intracranial pressure monitoring of a level-1 trauma center from 2002 till 2018 were analyzed. Patients with a cardiac history were excluded. An ECG recording was obtained within 24 h after ICU admission. Admission brain computerized tomography (CT)-scans were categorized by Marshall-criteria (diffuse vs. mass lesions) and for location of traumatic lesions. CT-characteristics and maximum Therapy Intensity Level (TILmax) were used as indicators for brain injury severity. We analyzed data of 198 patients, mean (SD) age of 40 ± 19 years, median GCS score 3 [interquartile range (IQR) 3–6], and 105 patients (53%) had thoracic injury. In-hospital mortality was 30%, with sudden death by cardiac arrest in four patients. The incidence of ECG abnormalities was 88% comprising ventricular repolarization disorders (57%) mostly with ST-segment abnormalities, conduction disorders (45%) mostly with QTc-prolongation, and arrhythmias (38%) mostly of supraventricular origin. More cardiac arrhythmias were observed with increased grading of diffuse brain injury (p = 0.042) or in patients treated with hyperosmolar therapy (TILmax) (65%, p = 0.022). No association was found between ECG abnormalities and location of brain lesions nor with thoracic injury. Multivariate analysis with baseline outcome predictors showed that cardiac arrhythmias were not independently associated with in-hospital mortality (p = 0.097). Only hypotension (p = 0.029) and diffuse brain injury (p = 0.017) were associated with in-hospital mortality. In conclusion, a high incidence of ECG abnormalities was observed in patients with severe TBI in the acute phase after injury. No association between ECG abnormalities and location of brain lesions or presence of thoracic injury was present. Cardiac arrhythmias were indicative for brain injury severity but not independently associated with in-hospital mortality. Therefore, our findings likely suggest that ECG abnormalities should be considered as cardiac mimicry representing the secondary effect of traumatic brain injury allowing for a more rationale use of neuroprotective measures.

Comparative Analysis on Traumatic Brain Injury Risk due to Primary and Secondary Impacts in a Vehicle-Pedestrian Sideswipe Accident

2016 ◽  
Author(s):  
Atsutaka Tamura ◽  
Junji Hasegawa ◽  
Takao Koide
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Risk ◽  
Velocity Change ◽  
Moving Vehicle ◽  
Point Potential ◽  
Regulatory Impact ◽  
Adult Head ◽  
Ground Impact ◽  
A Current

A series of vehicle-to-pedestrian sideswipe impacts were computationally reconstructed; a fast-walking pedestrian was collided laterally with the side of a moving vehicle at 25 or 40 km/h, which resulted in rotating the pedestrian’s body axially. Because of a limited interaction between the human body and striking vehicle, the struck pedestrian was projected transversely from the vehicle and fell to the ground close to the first impact point. Potential severity of traumatic brain injury (TBI) was assessed using linear and rotational acceleration pulses applied to the head and by measuring intracranial brain tissue deformation. We found that TBI risk due to a secondary head strike with the ground can be much greater than that due to a primary head strike with the vehicle. Further, an ‘effective’ head mass, meff, was computed based upon the impulse and velocity change involved in the secondary head strike, which mostly exceeded the mass of the adult head-form impactor (4.5 kg) commonly used for a current regulatory impact test for pedestrian safety assessment. Our results suggest that TBI risk due to a ground impact would be mitigated by actively controlling meff, because meff is closely associated with a pedestrian’s landing style in the final event of ground contact.

Rotational Acceleration Duration Affects Brain Strains in Lateral Impact

2007 ◽  
Author(s):  
Jianrong Li ◽  
Jiangyue Zhang ◽  
Narayan Yoganandan ◽  
Frank A. Pintar ◽  
Thomas A. Gennarelli
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Injuries ◽  
Motor Vehicle ◽  
Angular Acceleration ◽  
The United States ◽  
Physical Models ◽  
Lateral Impact ◽  
Diffuse Brain Injury ◽  
Diffuse Brain

Traumatic brain injury is a leading cause of disability and fatality in the United States. Approximately two million traumatic brain injury cases occur every year [1]. Motor vehicle crashes are a primary source [2]. Both clinical and laboratory studies have been conducted to understand injury mechanisms and establish injury thresholds [3, 4]. Physical models have also been used to investigate injury biomechanics [5, 6]. Angular acceleration is considered as a major cause of diffuse brain injuries (DBI) [7, 8], while the angular velocity is chosen as a suitable load descriptor for a diffuse brain injury criterion [4]. The present study is focused on the effect of angular acceleration duration on brain strains due to lateral impact.

A new model of diffuse brain injury in rats

1994 ◽  
Vol 80 (2) ◽  
pp. 291-300 ◽  
Author(s):  
Anthony Marmarou ◽  
Montasser A. Abd-Elfattah Foda ◽  
Wimer van den Brink ◽  
J. Campbell ◽  
H. Kita ◽  
...  
Keyword(s):  
Brain Injury ◽  
Mortality Rate ◽  
Cause Of Death ◽  
Skull Fracture ◽  
Guide Tube ◽  
Diffuse Brain Injury ◽  
Group 2 ◽  
The Impact ◽  
Diffuse Brain ◽  
Group 1

✓ This report describes the development of an experimental head injury model capable of producing diffuse brain injury in the rodent. A total of 161 anesthetized adult rats were injured utilizing a simple weight-drop device consisting of a segmented brass weight free-falling through a Plexiglas guide tube. Skull fracture was prevented by cementing a small stainless-steel disc on the calvaria. Two groups of rats were tested: Group 1, consisting of 54 rats, to establish fracture threshold; and Group 2, consisting of 107 animals, to determine the primary cause of death at severe injury levels. Data from Group 1 animals showed that a 450-gm weight falling from a 2-m height (0.9 kg-m) resulted in a mortality rate of 44% with a low incidence (12.5%) of skull fracture. Impact was followed by apnea, convulsions, and moderate hypertension. The surviving rats developed decortication flexion deformity of the forelimbs, with behavioral depression and loss of muscle tone. Data from Group 2 animals suggested that the cause of death was due to central respiratory depression; the mortality rate decreased markedly in animals mechanically ventilated during the impact. Analysis of mathematical models showed that this mass-height combination resulted in a brain acceleration of 900 G and a brain compression gradient of 0.28 mm. It is concluded that this simple model is capable of producing a graded brain injury in the rodent without a massive hypertensive surge or excessive brain-stem damage.

Time course for autoregulation recovery following severe traumatic brain injury

2009 ◽  
Vol 111 (4) ◽  
pp. 695-700 ◽  
Author(s):  
Gill E. Sviri ◽  
Rune Aaslid ◽  
Colleen M. Douville ◽  
Anne Moore ◽  
David W. Newell
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Severe Traumatic Brain Injury ◽  
Glasgow Coma Scale Score ◽  
Time Course ◽  
Diffuse Brain Injury ◽  
Severe Tbi ◽  
Diffuse Brain

Object The aim of the present study was to evaluate the time course for cerebral autoregulation (AR) recovery following severe traumatic brain injury (TBI) Methods Thirty-six patients (27 males and 9 females, mean ± SEM age 33 ± 15.1 years) with severe TBI underwent serial dynamic AR studies with leg cuff deflation as a stimulus, until recovery of the AR responses was measured. Results The AR was impaired (AR index < 2.8) in 30 (83%) of 36 patients on Days 3–5 after injury, and in 19 individuals (53%) impairments were found on Days 9–11 after the injury. Nine (25%) of 36 patients exhibited a poor AR response (AR index < 1) on postinjury Days 12–14, which eventually recovered on Days 15–23. Fifty-eight percent of the patients with a Glasgow Coma Scale score of 3–5, 50% of those with diffuse brain injury, 54% of those with elevated intracranial pressure, and 40% of those with poor outcome had no AR recovery in the first 11 days after injury. Conclusions Autoregulation recovery after severe TBI can be delayed, and failure to recover during the 2nd week after injury occurs mainly in patients with a lower Glasgow Coma Scale score, diffuse brain injury, elevated ICP, or unfavorable outcome. The finding suggests that perfusion pressure management should be considered in some of the patients for a period of at least 2 weeks.

scholarly journals Differential Leukocyte and Platelet Profiles in Distinct Models of Traumatic Brain Injury

Cells ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 500
Author(s):  
William Brad Hubbard ◽  
Meenakshi Banerjee ◽  
Hemendra Vekaria ◽  
Kanakanagavalli Shravani Prakhya ◽  
Smita Joshi ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Closed Head Injury ◽  
Diffuse Brain Injury ◽  
Blood Brain ◽  
Closed Head ◽  
Leukocyte Counts ◽  
Neutrophil Aggregation ◽  
Blood Leukocyte

Traumatic brain injury (TBI) affects over 3 million individuals every year in the U.S. There is growing appreciation that TBI can produce systemic modifications, which are in part propagated through blood–brain barrier (BBB) dysfunction and blood–brain cell interactions. As such, platelets and leukocytes contribute to mechanisms of thromboinflammation after TBI. While these mechanisms have been investigated in experimental models of contusion brain injury, less is known regarding acute alterations following mild closed head injury. To investigate the role of platelet dynamics and bioenergetics after TBI, we employed two distinct, well-established models of TBI in mice: the controlled cortical impact (CCI) model of contusion brain injury and the closed head injury (CHI) model of mild diffuse brain injury. Hematology parameters, platelet-neutrophil aggregation, and platelet respirometry were assessed acutely after injury. CCI resulted in an early drop in blood leukocyte counts, while CHI increased blood leukocyte counts early after injury. Platelet-neutrophil aggregation was altered acutely after CCI compared to sham. Furthermore, platelet bioenergetic coupling efficiency was transiently reduced at 6 h and increased at 24 h post-CCI. After CHI, oxidative phosphorylation in intact platelets was reduced at 6 h and increased at 24 h compared to sham. Taken together, these data demonstrate that brain trauma initiates alterations in platelet-leukocyte dynamics and platelet metabolism, which may be time- and injury-dependent, providing evidence that platelets carry a peripheral signature of brain injury. The unique trend of platelet bioenergetics after two distinct types of TBI suggests the potential for utilization in prognosis.

scholarly journals What are the strongest indicators of intracerebral hemorrhage in mild traumatic brain injury?

2021 ◽  
Vol 6 (1) ◽  
pp. e000717
Author(s):  
Panu Teeratakulpisarn ◽  
Phati Angkasith ◽  
Thanakorn Wannakul ◽  
Parichat Tanmit ◽  
Supatcha Prasertcharoensuk ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
High Risk ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Skull Fracture ◽  
Brain Ct ◽  
Baseline Characteristics ◽  
Gcs Score ◽  
The Brain

BackgroundAlthough there are eight factors known to indicate a high risk of intracranial hemorrhage (ICH) in mild traumatic brain injury (TBI), identification of the strongest of these factors may optimize the utility of brain CT in clinical practice. This study aimed to evaluate the predictors of ICH based on baseline characteristics/mode of injury, indications for brain CT, and a combination of both to determine the strongest indicator.MethodsThis was a descriptive, retrospective, analytical study. The inclusion criteria were diagnosis of mild TBI, high risk of ICH, and having undergone a CT scan of the brain. The outcome of the study was any type of ICH. Stepwise logistic regression analysis was used to find the strongest predictors according to three models: (1) injury pattern and baseline characteristics, (2) indications for CT scan of the brain, and (3) a combination of models 1 and 2.ResultsThere were 100 patients determined to be at risk of ICH based on indications for CT of the brain in patients with acute head injury. Of these, 24 (24.00%) had ICH. Model 1 found that injury due to motor vehicle crash was a significant predictor of ICH, with an adjusted OR (95% CI) of 11.53 (3.05 to 43.58). Models 2 and 3 showed Glasgow Coma Scale (GCS) score of 13 to 14 after 2 hours of observation and open skull or base of skull fracture to be independent predictors, with adjusted OR (95% CI) of 11.77 (1.32 to 104.96) and 5.88 (1.08 to 31.99) according to model 2.DiscussionOpen skull or base of skull fracture and GCS score of 13 to 14 after 2 hours of observation were the two strongest predictors of ICH in mild TBI.Level of evidenceIII.

scholarly journals Multisite medical record review of emergency department visits for traumatic brain injury

2021 ◽  
Vol 27 (S1) ◽  
pp. i42-i48
Author(s):  
Barbara A Gabella ◽  
Jeanne E Hathaway ◽  
Beth Hume ◽  
Jewell Johnson ◽  
Julia F Costich ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Skull Fracture ◽  
Signs And Symptoms ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
Intracranial Injury ◽  
Imaging Results ◽  
Icd 10

BackgroundIn 2016, the CDC in the USA proposed codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for identifying traumatic brain injury (TBI). This study estimated positive predictive value (PPV) of TBI for some of these codes.MethodsFour study sites used emergency department or trauma records from 2015 to 2018 to identify two random samples within each site selected by ICD-10-CM TBI codes for (1) intracranial injury (S06) or (2) skull fracture only (S02.0, S02.1-, S02.8-, S02.91) with no other TBI codes. Using common protocols, reviewers abstracted TBI signs and symptoms and head imaging results that were then used to assign certainty of TBI (none, low, medium, high) to each sampled record. PPVs were estimated as a percentage of records with medium-certainty or high-certainty for TBI and reported with 95% confidence interval (CI).ResultsPPVs for intracranial injury codes ranged from 82% to 92% across the four samples. PPVs for skull fracture codes were 57% and 61% in the two university/trauma hospitals in each of two states with clinical reviewers, and 82% and 85% in the two states with professional coders reviewing statewide or nearly statewide samples. Margins of error for the 95% CI for all PPVs were under 5%.DiscussionICD-10-CM codes for traumatic intracranial injury demonstrated high PPVs for capturing true TBI in different healthcare settings. The algorithm for TBI certainty may need refinement, because it yielded moderate-to-high PPVs for records with skull fracture codes that lacked intracranial injury codes.

scholarly journals Management of Traumatic Brain Injury: A review Update

2017 ◽  
Vol 6 (2) ◽  
pp. 87-89
Author(s):  
ATM Ashadullah ◽  
Monirul Islam ◽  
Fazley Elahi Milad ◽  
Abdullah Alamgir ◽  
Md Shafiul Alam
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injuries ◽  
Skull Fracture ◽  
Traumatic Injury ◽  
Loss Of Consciousness ◽  
Extradural Haematoma ◽  
Inner Surface ◽  
Injury Patient ◽  
Extradural Haematomas

Traumatic Brain Injury leads to serious consequences. Approximately half of all deaths is related to traumatic injury and the main cause of head trauma. Extradural haematomas (EDH) develops in all major head injuries. A head injury patient who is only temporary loss of consciousness and is left asleep may sometimes be found dead in the bed next morning due to extradural haematoma. Extradural haematoma which lies in between the inner surface of skull and stripes of dural membrane, are nearly always caused by, and located near a skull fracture. The collection takes several forms in terms of size, location, speed of development and effects they exert on patient. Immediate management is necessary to decrease the bad consequences. In this review the management of traumatic brain injury is highlighted.J Shaheed Suhrawardy Med Coll, 2014; 6(2):87-89

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