Select Isolated Pediatric Closed Head Injuries can be safely managed on a Nonsurgical Service

2016 ◽  
Vol 5 (2) ◽  
pp. 65-69
Author(s):  
Dan Parrish ◽  
Shannon Rosati ◽  
Malkit Singh ◽  
Andrew Green ◽  
Jeffrey Haynes
Keyword(s):  
Injury Severity ◽  
Social Issues ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Pediatric Neurosurgery ◽  
The United States ◽  
Inclusion Criteria ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Gcs Score

ABSTRACT Introduction Annually in the United States, there are an estimated 474,000 traumatic brain injury (TBI) related Emergency Department (ED) visits in children under age 15 years. While their evaluation and management are not standardized, guidelines generally include a neurological examination and head computed tomography (CT) with neurosurgical and/or pediatric surgical consultation, and admission generally based on imaging as well as persistent neurological symptoms. The primary purpose of this study was to review our experience with admitted isolated closed head injuries in children. We evaluated the safety of their management on a nonsurgical service after ED pediatric neurosurgical consultation deemed the injuries nonoperative. Study design A retrospective review was conducted of pediatric patients with closed head injuries between 2008 and 2013 (n = 837). Inclusion criteria were isolated closed head injury, discharged within 48 hours of admission, Glasgow Coma Scale (GCS) score greater than 13, and admission to a nonsurgical service. A total 272 patients met the inclusion criteria. These patients were divided into two groups based on whether or not they received a neurosurgical consult. Results Of the 272 patients, 221 received a pediatric neurosurgery consult while 51 did not. Those that received a neurosurgical consult had a higher Injury Severity Score (ISS) (7.5 vs 3.6), younger age (4.4 vs 6.9), longer length of stay, higher admission acuity, and were more likely to receive a repeat head CT. There was no difference in GCS score (14.9 vs 15), and the most common discharge symptom was a headache. With admission to nonsurgical services, no complications, readmissions, or missed injuries occurred. Conclusion As pediatric neurosurgery is a limited resource, we evaluated the safety of admitting patients deemed nonsurgical to a medical service for management and follow-up of the TBI, as well as the social issues which are often present. The practice resulted in no morbidity or mortality with efficient management of ancillary consult services. How to cite this article Parrish D, Rosati S, Singh M, Green A, Haynes J. Select Isolated Pediatric Closed Head Injuries can be safely managed on a Nonsurgical Service. Panam J Trauma Crit Care Emerg Surg 2016;5(2):65-69.

Inappropriate Discharge Instructions for Youth Athletes Hospitalized for Concussion

PEDIATRICS ◽  
1995 ◽  
Vol 95 (2) ◽  
pp. 216-218
Author(s):  
Frank J. Genuardi ◽  
William D. King
Keyword(s):  
Head Injury ◽  
Injury Severity ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Medical Society ◽  
Discharge Instructions ◽  
Youth Athletes ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Grade 3

Objective. To evaluate the medical care, especially the discharge instructions regarding return to participation, received by youth athletes hospitalized for a closed head injury. Methods. We examined the records of all patients admitted over a 5-year period (1987 through 1991) to The Children's Hospital of Alabama for a sports-related closed head injury. Descriptive information was recorded and discharge instructions reviewed. Injury severity was graded according to guidelines current during the study period, as well as those outlined most recently by the Colorado Medical Society, which have been endorsed by a number of organizations including the American Academy of Pediatrics. Discharge instructions recorded for each patient were then compared with those recommended in the guidelines. Results. We identified 33 patients with sports-related closed head injuries. Grade 1 concussions (least severe) occurred in 8 patients (24.2%), grade 2 in 10 (30.3%), and grade 3 (most severe) in 15 (45.4%). Overall, discharge instructions were appropriate for only 10 patients (30.3%), including all with grade 1 concussions, but only 2 with a grade 2 (20.0%) and none with a grade 3 concussion. Conclusion. All who care for youth athletes must become familiar with the guidelines for management of concussion to provide appropriate care and counseling and to avoid a tragic outcome.

Verbal learning and memory following pediatric closed-head injury

1995 ◽  
Vol 1 (1) ◽  
pp. 78-87 ◽  
Author(s):  
Keith Owen Yeates ◽  
Elliot Blumenstein ◽  
Carolyn M. Patterson ◽  
Dean C. Delis
Keyword(s):  
Learning And Memory ◽  
Injury Severity ◽  
Head Injuries ◽  
Verbal Learning ◽  
Closed Head Injury ◽  
California Verbal Learning Test ◽  
Closed Head Injuries ◽  
Closed Head ◽  
History Of ◽  
Learning Test

AbstractIn this study, verbal learning and memory following pediatric closed-head injuries (CHI) using the children's version of the California Verbal Learning Test (CVLT). Participants included 47 children, ages 5–16 yr, with a history of CHI, and 47 matched, noninjured controls. Children with CHI performed more poorly than controls on the CVLT, although their deficits varied qualitatively as a function of injury severity. Those with mild/moderate injuries performed as well as controls on learning trials, but they recalled proportionally fewer words after a delay (although their recognition was intact). Severely injured children demonstrated deficits in learning, delayed recall, and recognition, compared to controls. The groups did not differ in learning characteristics, but children with severe CHI exhibited more intrusions than controls. Pediatric CHI are associated with specific disturbances in verbal learning and memory similar to those of adults with CHI but different from those of children with other developmental and neurological disorders.JINS, 1995,I, 78–87.)

scholarly journals A Retrospective Analysis of Softball-Related Head and Facial Injuries Treated in United States Emergency Departments, 2013-2017

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982566 ◽  
Author(s):  
John S. Strickland ◽  
Marie Crandall ◽  
Grant R. Bevill
Keyword(s):  
United States ◽  
Head Injuries ◽  
The United States ◽  
Weighted Estimate ◽  
Body Parts ◽  
Facial Injuries ◽  
Closed Head Injuries ◽  
Closed Head ◽  
The Mean ◽  
Race Ethnicity

Background: Softball is a popular sport played through both competitive and recreational leagues. While head and facial injuries are a known problem occurring from games, little is known about the frequency or mechanisms by which they occur. Purpose: To analyze head/face injury diagnoses and to identify the mechanisms associated with such injuries. Study Design: Descriptive epidemiological study. Methods: A public database was used to query data related to head/facial injuries sustained in softball. Data including age, sex, race/ethnicity, injury diagnosis, affected body parts, disposition, incident location, and narrative descriptions were collected and analyzed. Results: A total of 3324 head and face injuries were documented in the database over the time span of 2013 to 2017, resulting in a nationwide weighted estimate of 121,802 head/face injuries occurring annually. The mean age of the players was 21.5 ± 14.4 years; 72.1% of injured players were female, while 27.9% were male. The most common injury diagnoses were closed head injuries (22.0%), contusions (18.7%), concussions (17.7%), lacerations (17.1%), and fractures (15.1%). The overwhelming majority of injuries involved being struck by a ball (74.3%), followed by colliding with another player (8.3%), colliding with the ground or a fixed object (5.0%), or being struck by a bat (2.8%). For those injuries caused by a struck-by-ball incident, most occurred from defensive play (83.7% were fielders struck by a hit or thrown ball) as opposed to offensive play (12.3% were players hit by a pitch or runners struck by a ball). Although helmet usage was poorly tracked in the database, female players (1.3%) were significantly more likely to have been wearing a helmet at the time of injury than were male players (0.2%) ( P = .002). Conclusion: The present study demonstrates that a large number of head and face injuries occur annually within the United States as a result of softball play. A variety of injuries were observed, with the majority involving defensive players being struck by the ball, which highlights the need for more focus on player safety by stronger adherence to protective headgear usage and player health monitoring.

All-Terrain Vehicle Injuries: Are They Dangerous? A 6-Year Experience at a Level I Trauma Center after Legislative Regulations Expired

2005 ◽  
Vol 71 (11) ◽  
pp. 937-941 ◽  
Author(s):  
A.H. Fonseca ◽  
M.G. Ochsner ◽  
W.J. Bromberg ◽  
D. Gantt
Keyword(s):  
Injury Severity ◽  
Public Awareness ◽  
Head Injuries ◽  
Progressive Increase ◽  
Helmet Use ◽  
Closed Head Injuries ◽  
Safety Regulations ◽  
Number Of Patients ◽  
Closed Head ◽  
Level I

All-terrain vehicles (ATVs) have increased in popularity and sales since 1971. This rise in popularity led to an increase in injuries resulting in voluntary industry rider safety regulations in 1988, which expired without renewal in 1998. Our purpose was twofold, to determine the incidence and severity of ATV injuries in our patient population and what, if any impact the safety regulations had. To further characterize the risk of ATV use, we compared them to a vehicle generally recognized as dangerous, the motorcycle (MC). Our trauma registry was reviewed from January 1998 through August 2004 for ATV or MC injured. Data collected included age, gender, mortality, Injury Severity Score (ISS), helmet use, and injury distribution. These were compared to our data from the decade of regulation. There were 352 MC and 221 ATV patients. ATV injured demonstrated a higher proportion of pediatric and female patients ( P < 0.001 and P < 0.01, respectively), a decrease in helmet use (8.6% vs 64.7%, P < 0.001), and increased closed head injuries (CHI) (54.2% vs 44.9%, P < 0.05) compared with MC injured. ISS and mortality were similar. The average number of patients from 1988 to 1998 was 6.9/yr compared to 31.6/yr ( P < 0.001) during 1998–2004 with equal ISS. Our data show that there has been a dramatic and progressive increase in the number of ATV crashes since expiration of industry regulations. ATVs are as dangerous as MCs based on patient ISS and mortality. There are significantly more children and women injured on ATVs. The lower rate of helmet use in ATVs may account for the significantly greater incidence of CHI. These data mandate the need for injury prevention efforts for ATV riders, in particular children, through increased public awareness and new legislation.

Neuroleptic Malignant Syndrome Complicating Closed Head Injury

Neurosurgery ◽  
1986 ◽  
Vol 18 (2) ◽  
pp. 190-193 ◽  
Author(s):  
Frederick M. Vincent ◽  
J. Eric Zimmerman ◽  
James Van Haren
Keyword(s):  
Creatine Kinase ◽  
Head Injury ◽  
Neuroleptic Malignant Syndrome ◽  
Complete Resolution ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Treatment Modalities ◽  
Dantrolene Sodium ◽  
Closed Head Injuries ◽  
Closed Head

Abstract Lethargy, hyperpyrexia, tremor, and rigidity associated with leukocytosis and elevation of the creatine kinase level occurred in a patient with a closed head injury who was being treated with haloperidol for control of agitation. This constellation of symptoms, known as the neuroleptic malignant syndrome (NMS), partially improved when the neuroleptic medication was stopped, but complete resolution of the syndrome did not occur until the patient was treated with bromocriptine. Because haloperidol is the most widely used medication for the agitation that develops in patients with significant closed head injuries, neurosurgeons should be aware of the NMS. The NMS is caused by neuroleptic medications and may initially present with unexplained hyperpyrexia, leukocytosis, and elevated creatine kinase levels. Halting the neuroleptic, supportive care, and the use of dantrolene sodium and bromocriptine are the treatment modalities of choice for this syndrome, which has a mortality rate of 20 to 30% and may be linked to malignant hyperthermia.

scholarly journals Epidemiology of Cheerleading Fall-Related Injuries in the United States

2009 ◽  
Vol 44 (6) ◽  
pp. 578-585 ◽  
Author(s):  
Brenda J. Shields ◽  
Gary A. Smith
Keyword(s):  
Cruciate Ligament ◽  
Head Injuries ◽  
The United States ◽  
Severe Injuries ◽  
Closed Head Injuries ◽  
Wood Floor ◽  
Closed Head ◽  
Serious Injury ◽  
The Impact ◽  
Fall Height

Abstract Context: Over the past several decades, cheerleaders have been performing fewer basic maneuvers and more gymnastic tumbling runs and stunts. As the difficulty of these maneuvers has increased, cheerleading injuries have also increased. Objective: To describe the epidemiology of cheerleading fall-related injuries by type of cheerleading team and event. Design: Prospective injury surveillance study. Setting: Participant exposure and injury data were collected from US cheerleading teams via the Cheerleading RIO (Reporting Information Online) surveillance tool. Patients or Other Participants: Athletes from 412 enrolled cheerleading teams who participated in official, organized cheerleading practices, pep rallies, athletic events, or cheerleading competitions. Main Outcome Measure(s): The numbers and rates of cheerleading fall-related injuries during a 1-year period (2006–2007) are reported. Results: A total of 79 fall-related injuries were reported during the 1-year period. Most occurred during practice (85%, 67/79) and were sustained by high school cheerleaders (51%, 40/79). A stunt or pyramid was being attempted in 89% (70/79) of cases. Fall heights ranged from 1 to 11 ft (0.30–3.35 m) (mean  =  4.7 ± 2.0 ft [1.43 ± 0.61 m]). Strains and sprains were the most common injuries (54%, 43/79), and 6% (5/79) of the injuries were concussions or closed head injuries. Of the 15 most serious injuries (concussions or closed head injuries, dislocations, fractures, and anterior cruciate ligament tears), 87% (13/15) were sustained while the cheerleader was performing on artificial turf, grass, a traditional foam floor, or a wood floor. The fall height ranged from 4 to 11 ft (1.22–1.52 m) for 87% of these cases (13/15). Conclusions: Cheerleading-related falls may result in severe injuries and even death, although we report no deaths in the present study. The risk for serious injury increases as fall height increases or as the impact-absorbing capacity of the surfacing material decreases (or both).

scholarly journals Variations in the Presentation of Aphasia in Patients with Closed Head Injuries

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Dara Oliver Kavanagh ◽  
Conor Lynam ◽  
Thorsten Düerk ◽  
Mary Casey ◽  
Paul W. Eustace
Keyword(s):  
Head Injury ◽  
Early Recognition ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Favourable Outcome ◽  
Speech And Language ◽  
Closed Head Injuries ◽  
Closed Head ◽  
The Common ◽  
Surgical Unit

Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome.

scholarly journals Progress in Cheerleading Safety: Update on the Epidemiology of Cheerleading Injuries Presenting to US Emergency Departments, 2010-2019

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110388
Author(s):  
Amy L. Xu ◽  
Krishna V. Suresh ◽  
R. Jay Lee
Keyword(s):  
Hospital Admission ◽  
Emergency Departments ◽  
Hospital Admissions ◽  
Head Injuries ◽  
Injury Rate ◽  
The United States ◽  
Annual Number ◽  
Hospital Admission Rate ◽  
Closed Head Injuries ◽  
Closed Head

Background: Although the athleticism required of cheerleaders has increased, the risks of cheerleading have been less studied as compared with other sports. Purpose: To update our understanding of the epidemiology of cheerleading-related injuries. Study Design: Descriptive epidemiology study. Methods: We analyzed the National Electronic Injury Surveillance System (NEISS) for cheerleading-related injuries presenting to nationally representative emergency departments (EDs) in the United States from January 2010 through December 2019. Extracted data included patient age and sex, injury characteristics (diagnosis, body region injured, time of year, and location where injury occurred), and hospital disposition. Using patient narratives, we recorded the cheerleading skills, settings, and mechanisms that led to injury. NEISS sample weights were used to derive national estimates (NEs) from actual case numbers. Results: From 2010 to 2019, a total of 9868 athletes (NE = 350,000; 95% CI, 250,000-450,000) aged 5-25 years presented to US EDs for cheerleading injuries. The annual number of injuries decreased by 15%, from 982 (NE = 35,000; 95% CI, 27,000-44,000) to 897 (NE = 30,000; 95% CI, 18,000-42,000) ( P = .048), corresponding to a 27% decline in the injury rate per 100,000 cheerleaders ( P < .01). The annual number of injuries caused by performing stunts decreased by 24%, from 240 (NE = 8700; 95% CI, 6700-11,000) to 216 (NE = 6600; 95% CI, 4000-9200) ( P = .01), with a 36% decline in the corresponding injury rate per 100,000 cheerleaders ( P < .01). Despite these decreases, annual incidence of concussions/closed head injuries increased by 44%, from 128 (NE = 3800; 95% CI, 2900-4700) to 171 (NE = 5500; 95% CI, 3400-7700) ( P = .02), and patients requiring hospital admission increased by 118%, from 18 (NE = 330; 95% CI, 250-410) to 24 (NE = 720; 95% CI, 440-1000) ( P < .01). The hospital admission rate increased by 9.0% ( P = .02). Conclusion: The number of cheerleading-related injuries presenting to US EDs decreased from 2010 to 2019. However, the incidence of concussions/closed head injuries and hospital admissions increased, suggesting that further measures are needed to improve safety for cheerleaders.

Equestrian Trauma: Injury Patterns Vary among Age Groups

2014 ◽  
Vol 80 (4) ◽  
pp. 396-402 ◽  
Author(s):  
Jaroslaw W. Bilaniuk ◽  
John M. Adams ◽  
Louis T. DiFazio ◽  
Brian K. Siegel ◽  
John R. Allegra ◽  
...  
Keyword(s):  
Injury Severity ◽  
Head Injuries ◽  
A Priori ◽  
Age Groups ◽  
Rib Fractures ◽  
Body Region ◽  
Injury Patterns ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Trauma Injury

Patients with equestrian injuries were identified in the trauma registry from 2004 to 2007. We a priori divided patients into three groups: 0 to 18 years, 19 to 49 years, and 50 years old or older. There were 284 patients identified with equestrian-related trauma. Injury Severity Score for the three major age categories 0 to 18 years, 19 to 49 years, and 50 years or older, were 3.47, 5.09, and 6.27, respectively. The most common body region injured among all patients was the head (26.1%). The most common injuries by age group were: 0 to 18 years, upper extremity fractures; 19 to 49 year olds, concussions; and 50 years or older, rib fractures. Significant differences were observed among the three age groups in terms of percent of patients with rib fractures: percent of patients with rib fractures was 2, 8, and 22 per cent in age groups 0 to 18, 19 to 49, and 50 years or older, respectively. We found different patterns of injuries associated with equestrian accidents by age. Head injuries were commonly seen among participants in equestrian activities and helmet use should be promoted to minimize the severity of closed head injuries. Injury patterns also seem to vary among the various age groups that ride horses. This information could be used to better target injury prevention efforts among these patients.

scholarly journals Psychological and neuropsychological correlates of postconcussional disorder

2008 ◽  
Author(s):  
Joy Helena Wymer B.S.
Keyword(s):  
United States ◽  
Head Injury ◽  
Brain Injuries ◽  
Spinal Injury ◽  
Head Injuries ◽  
The United States ◽  
Emergency Room Visits ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Risk Takers

Each year approximately 2 million people in the United States suffer closed head injuries (CHI); approximately 500,000 are severe enough to require hospitalization (Brown, Fann & Grant, 1994). Other researchers have estimated the incidence of CHI in the United States at over 9 million (Miller & Berenguer-Gil, 1994). CHI account for about 10% of all emergency room visits (Sherer, Madison & Hannay, 2000). This number has recently decreased, possibly due to decreased hospitalization of individuals with mild brain injuries. According to the National Head Injury and Spinal Injury Survey of 1980, the typical male is four times more likely to experience a head injury than a female (Kalsbeek, McLaughlin, Harris & Miller, 1980). Men are believed to sustain more head injuries because they have been found to be greater risk-takers, more likely to be engaged in potentially dangerous work, more impulsive, and more likely to abuse alcohol or drugs. Alcohol is reported to be involved in 30% of head injuries suffered by males and 10% of those suffered by females (Bennett, 1987).

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