Clinic and diagnostics of the non-penetrating gun-shoot craniocerebral injuries in the local war

Objective ‒ to evaluate the features of the clinical manifestations and effectiveness of multi-slice computed tomography (MSCT) of the head for the diagnosis of non-penetrating gun-shoot head injuries in the local war.Materials and methods. The medical data of 155 patients who received a non-penetrating gun-shoot head injuries during the war in the Eastern Ukraine between 2014‒2020 were analyzed. All patients were males between 18 and 60 years (average age ‒ 35.1 years). The peculiarities of clinical manifestations and results of diagnostic evaluation of non-penetrating gun-shoot head injuries during specialized neurosurgical care in medical institutions on the third and fourth levels of medical aid have been studied.Results. Wide diagnostic capabilities of MSCT were revealed for determination of the wounds localization, type of the projectile, the nature of the wound channel, gunshot skull fractures, and associated intracranial injuries. It was found that with non-penetrating bullet and shrapnel tangential cranio-cerebral wounds, incomplete and depressed fractures usually occurred, and with single and multiple shrapnel blind wounds, incomplete ‒ perforated and depressed fractures with the presence of bone fragments. The pathomorphological features of the nature of the wound channels and intracranial injuries were determined. They are always associated by traumatic subarachnoid hemorrhages and brain contusions, in most cases – focal. Intracranial hematomas were observed in 3.1 % of the patients.Conclusions. Clinical manifestations of the non-penetrating craniocerebral gunshot wounds depend not only on the type of cranial soft tissue injury, but also on the nature of the skull fracture and are mainly occurred because of the severity of the traumatic brain injury. MSCT of the head makes it possible to determine the localization of the wound, the type of the wounding projectile, the nature of the cranial soft tissues damage, wound channel, gunshot skull fractures and associated intracranial injuries.

Trends in hospital admissions for childhood fractures in England

PurposeFractures to the axial and appendicular skeleton are common in children causing loss of opportunities and disability. There are relatively few studies available to quantify the number of children who have their fractures diagnosed in the emergency department and are then admitted to hospital for ongoing management. The purpose of this study is to explore trends of frequency, types and age of children sustaining fractures who were admitted for intervention to National Health Service (NHS) hospitals.DesignThe study uses data from the Hospital Episode Statistics and Office for National Statistics from 2012 to 2019 to calculate the annual incidence of hospital admission for limb, spine, facial and skull fractures per 100 000 children.ResultsDuring 2012–2019, 368 120 children were admitted to English NHS hospitals with a fracture. 256 008 (69.5%) were upper limb fractures, 85 737 (23.3%) were lower limb fractures and 20 939 (5.7%) were skull or facial fractures. The annual incidence of upper limb fractures was highest in children aged 5–9 (348.3 per 100 000 children) and the highest incidence of lower limb fractures was in children aged 10–15 (126.5 per 100 000 children). The incidence of skull and facial fractures in preschool (age 0–4) children has been increasing at a rate of 0.629 per 100 000 children per year.ImplicationsThe annual incidence of hospital admission for fractures in children has been shown to be consistent for several fracture types between 2012 and 2019. An increasing trend of admissions with preschool skull fractures was observed, though the study data do not have sufficient granularity to demonstrate if this is due to changes in practice or to accidental or non-accidental causes.

Ultrasound in Detection of Skull Fractures in Children Younger Than Two Years Old with Closed Head Injuries

Background Paediatrics head injuries is a frequent cause of emergency department (ER) visits. The incidence of head traumas in children varies from one country to other with an estimated 47 to 280 per 100,000 children presented to the ER each year due to traumatic brain injury worldwide. Head computed tomography (CT) is the most frequent CT scan performed in paediatrics population, majority of those scans are done to evaluate trauma. Head CT scans increase the risk of developing brain malignancies and leukemia in exposed pediatric patients. Many efforts have been made to limit the use of CT in children with head injuries. Aim of the Work Our aim was to evaluate the role of skull ultrasound in detection of skull fractures children younger than two years old with closed head injuries. Patients and Methods Type of study was a prospective observational study, sampling method was convenient sampling. The study was conducted according to the stipulations of the Ain Shams University (ASU) ethical and scientific committee. The privacy of participants and confidentiality of data was guaranteed during the various phases of the study. The study was conducted at the radiology unit, Emergency Department, ASU Hospital. The main source of data for this study was patients referred to the Emergency department. Children younger than 2 years presenting with closed head injuries and referred to the radiology department, ASU hospital to perform CT brain, Study Period: 6 months, onset in March 2020. Results We found that skull ultrasound examination of pediatric patients with closed head injuries and Glasgow coma scale (GCS) of 14-15 have a high sensitivity and specificity in detecting skull fractures and subsequently prediction of an underlying traumatic brain injury (TBI) in these patients. Ultrasonographic assessment of the whole cranial vault is not always feasible as most of these age group patients are excessively crying and irritable at presentation, applying the ultrasound probe makes them more irritable and are difficult to maintain their head position during the scan. Although head CT is the gold standard diagnostic modality in the setting of head trauma, it exposes patients to significant ionizing radiation, ultrasonography is a safe diagnostic modality and doesn’t expose the patient to ionizing radiation. Conclusion Skull ultrasound in the setting of pediatrics mild closed head injuries is feasible, safe, sensitive and specific. It can play a complementary rule in risk stratification of these patients.

Analysis of cranio-cerebral injuries in vehicular accident victims in south Bangalore: A two-year retrospective study

Road traffic accidents are regarded as the most common non communicable epidemics of the world. They are also a major cause for morbidity and mortality. The most common and vulnerable part of the body which is affected during road accidents is the head. This study was done at KIMS hospital Bangalore with an aim to observe the range of cranio-cerebral injuries by analysing the postmortem records between January 2011 to December 2012 retrospectively, which would provide valuable data for implementing effective emergency services to reduce trauma related mortality. During the 2-year study period the study population had a total of 143 decedents ranging between age 5 years to 84 years. Victims of both sexes comprised the study population. The spectrum of head injuries with respect to incidence of skull fractures and type of intracranial haemorrhage were noted. Male predominance was seen over females in 83% of cases. The most common age group to be affected was between 21-30 years, who made 30% of study population. 52% of the decedents had skull fractures, of which 50% of them had sub-arachnoid haemorrhage followed by 47% of decedents with sub-dural hemorrhage. Pedestrians accounted to 38% of the decedents while the remainder 62% accounted for vehicular occupants.