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Emergency Medicine International 2022Skull fractures are often found in patients with traumatic brain injury (TBI). Although skull fractures may indicate greater force impact and are associated with local...
INTRODUCTION
Skull fractures are often found in patients with traumatic brain injury (TBI). Although skull fractures may indicate greater force impact and are associated with local or diffuse brain injuries, the prognostic value of skull fractures remains unclear. This retrospective study aimed to assess the association between skull fractures and mortality in patients with TBI.
METHODS
This study included 5,430 TBI patients registered in the trauma registry system from January 2009 to December 2018. Clinical and demographic data including age, sex, trauma mechanisms, comorbidities, Glasgow Coma Scale (GCS) score, abbreviated injury score (AIS)-head, injury severity score (ISS), and in-hospital mortality were acquired. Multiple logistic regression and propensity score matching were used to elucidate the effect of skull fractures on mortality outcomes of TBI patients.
RESULTS
Compared to TBI patients without skull fracture, patients with skull fractures were predominantly male, younger, had lower GCS upon arrival at the emergency room, and had higher AIS-head, ISS, and in-hospital mortality. The patients with skull fracture had 1.7-fold adjusted odds of mortality (95% confidence interval (CI): 1.27-2.25; < 0.001) than those without skull fracture, controlling for age, sex, comorbidities, and AIS-head. Additionally, the propensity score-matched analysis of 1,023 selected paired patients revealed that skull fracture was significantly associated with increased 1.4-fold odds of risk for mortality (95% CI: 1.02-1.88; =0.036).
CONCLUSIONS
Using a propensity score-matched cohort to attenuate the confounding effect of age, comorbidities, and injury severity, skull fracture was identified as a significant independent risk factor for mortality in patients with TBI.
PubMed: 35712231
DOI: 10.1155/2022/1296590 -
Journal of Veterinary Internal Medicine Sep 2020Traumatic skull fractures (TSF) are relatively frequent in dogs and cats, but little information is available regarding their clinical and imaging features.
BACKGROUND
Traumatic skull fractures (TSF) are relatively frequent in dogs and cats, but little information is available regarding their clinical and imaging features.
HYPOTHESIS/OBJECTIVES
To describe the neurological and computed tomographic (CT) features of a large cohort of dogs and cats with TSF.
ANIMALS
Ninety-one dogs and 95 cats with TSF identified on CT.
METHODS
Multicenter retrospective comparative study. Signalment, cause of trauma, fracture locations and characteristics, presence of neurological deficits, and 1-week survival were recorded. Fractures were classified according to the extent of fragmentation and displacement.
RESULTS
The cranial vault was affected more frequently in dogs (P = .003), whereas the face and base of the cranium more often was affected in cats (P < .001). Cats presented with multiple fractures more frequently (P < .001). All animals with TSF in the cranial vault were more likely to develop neurological signs (P = .02), especially when depressed fractures were present (95% confidence interval [CI], 1.7-8.2; P = .001). Animals with TSF located only in the facial region were less likely to have neurological signs (odds ratio with Mantel-Haenszel's method [OR ], 0.2; 95% CI, 0.1-0.6; P = .004). Most affected animals (84.9%) survived the first week post-trauma. Death was more likely with fractures of the cranial vault (P = .003), especially when fragmented (P = .007) and displaced (P = .004).
CONCLUSIONS AND CLINICAL IMPORTANCE
Traumatic skull fracture distribution and patterns are different between dogs and cats. Cranial vault fractures were associated with neurological deficits and worse survival. The presence of TSF alone should not be considered a negative prognostic factor because most affected animals survived the first week.
Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Retrospective Studies; Skull; Skull Fractures; Tomography, X-Ray Computed
PubMed: 32686202
DOI: 10.1111/jvim.15838 -
Children (Basel, Switzerland) Dec 2023The impact of traumatic brain injury (TBI) on the pediatric population is profound. The aim of this study is to unveil the state of the evidence concerning acute... (Review)
Review
BACKGROUND
The impact of traumatic brain injury (TBI) on the pediatric population is profound. The aim of this study is to unveil the state of the evidence concerning acute neurosurgical intervention, hospitalizations after injury, and neuroimaging in isolated skull fractures (ISF).
MATERIALS AND METHODS
This systematic review was conducted in accordance with PRISMA guidelines. PubMed, Cochrane, Web of Science, and Embase were searched for papers until April 2023. Only ISF cases diagnosed via computed tomography were considered.
RESULTS
A total of 10,350 skull fractures from 25 studies were included, of which 7228 were ISF. For the need of acute neurosurgical intervention, the meta-analysis showed a risk of 0% (95% CI: 0-0%). For hospitalization after injury the calculated risk was 78% (95% CI: 66-89%). Finally, for the requirement of repeated neuroimaging the analysis revealed a rate of 7% (95% CI: 0-15%). No deaths were reported in any of the 25 studies.
CONCLUSIONS
Out of 7228 children with ISF, an almost negligible number required immediate neurosurgical interventions, yet a significant 74% were hospitalized for up to 72 h. Notably, the mortality was zero, and repeat neuroimaging was uncommon. This research is crucial in shedding light on the outcomes and implications of pediatric TBIs concerning ISFs.
PubMed: 38136115
DOI: 10.3390/children10121913 -
Journal of Oral and Maxillofacial... Aug 2022As the geriatric population continues to increase, more elderly patients with maxillofacial injuries are encountered in emergency rooms. It can be hypothesized that...
PURPOSE
As the geriatric population continues to increase, more elderly patients with maxillofacial injuries are encountered in emergency rooms. It can be hypothesized that advanced age increases the risk of associated injuries (AIs). The purpose of the study was to estimate the frequency of AI and measure the association between age and risk for AI among a sample of patients with facial fractures.
METHODS
A retrospective cohort study was designed and implemented. The study sample comprised patients aged 18 years or older who presented to the Töölö Trauma Centre, Helsinki University Hospital, Finland, between 2013 and 2018 for diagnosis and treatment of facial fractures. The primary outcome variable was the presence or absence of AI. AI was defined as any major injury outside the facial region, including injuries to brain, major vessels, internal organs or respiratory organs, and fractures. Secondary outcome variables were affected organ system (classified as brain, cranial bone, neck, upper extremity, lower extremity, chest, spine, and abdomen), number of affected organ systems (classified as 1 and ≥2), need for intensive care, and mortality. The primary predictor variable was age (adults vs elderly). Controlled variables were sex, mechanism of trauma, intoxication by alcohol, and type of facial fracture. Descriptive statistics, univariable, and multivariable logistic regression analysis were executed to measure the association between age groups and AI. P value less than .05 was set as the threshold for statistical significance.
RESULTS
Of the total 2,682 patients, 1,931 (72.0%) were adults, and 751 (28.0%) were elderly. Elderly had a 1.6-fold risk (95% confidence interval [CI], 1.5-1.8; P < .001) of AIs as compared with adults. Moreover, after adjusting for mechanism of trauma and type of facial fracture, elderly had 1.8 times greater odds for injuries to 2 or more organ systems (95% CI, 1.3-2.5; P < .001), 2.2 times greater odds for brain injuries (95% CI, 1.6-2.9; P < .001), 2.3 times greater odds for neck injuries (95% CI, 1.5-3.6; P < .001), and 6.8 times greater odds for mortality (95% CI, 2.9-15.6; P < .001).
CONCLUSION
Elderly patients have AIs significantly more frequently than younger adults. Age-specific features should be taken into consideration in the multiprofessional evaluation and treatment of facial fracture patients.
Topics: Adult; Aged; Humans; Maxillofacial Injuries; Neck Injuries; Retrospective Studies; Skull; Skull Fractures
PubMed: 35636472
DOI: 10.1016/j.joms.2022.04.018 -
Atlas of the Oral and Maxillofacial... Mar 2021
Review
Topics: Humans; Orbital Fractures; Orthoptics
PubMed: 33516539
DOI: 10.1016/j.cxom.2020.10.002 -
International Journal of Legal Medicine Nov 2023Forensic pathologists may use 3D prints as demonstrative aids when providing expert testimony in court of law, but the effects remain unclear despite many assumed...
Forensic pathologists may use 3D prints as demonstrative aids when providing expert testimony in court of law, but the effects remain unclear despite many assumed benefits. In this qualitative study, the effects of using a 3D print, demonstrating a blunt force skull fracture, in court were explored by thematic analysis of interviews with judges, prosecutors, defence counsels, and forensic pathologists with the aim of improving the expert testimony. Five semi-structured focus groups and eight one-to-one interviews with a total of 29 stakeholders were transcribed ad verbatim and analysed using thematic analysis. The study found that a highly accurate 3D print of a skull demonstrated autopsy findings in detail and provided a quick overview, but sense of touch was of little benefit as the 3D print had different material characteristics than the human skull. Virtual 3D models were expected to provide all the benefits of 3D prints, be less emotionally confronting, and be logistically feasible. Both 3D prints and virtual 3D models were expected to be less emotionally confronting than autopsy photos. Regardless of fidelity, an expert witness was necessary to translate technical language and explain autopsy findings, and low-fidelity models may be equally suited as demonstrative aids. The court infrequently challenged the expert witnesses' conclusions and, therefore, rarely had a need for viewing autopsy findings in detail, therefore rarely needing a 3D print.
Topics: Humans; Printing, Three-Dimensional; Expert Testimony; Skull Fractures; Focus Groups; Male; Female; Autopsy; Interviews as Topic; Qualitative Research; Forensic Pathology; Adult; Skull
PubMed: 37391670
DOI: 10.1007/s00414-023-03054-6 -
Scientific Reports Nov 2023Despite efforts of many countries to improve pedestrian safety, international reports show an upward trend in pedestrian-motor vehicle accidents. Although the most...
Despite efforts of many countries to improve pedestrian safety, international reports show an upward trend in pedestrian-motor vehicle accidents. Although the most common cause of death of pedestrians is head injuries, there is a lack of knowledge on the epidemiology and characteristics of head injury in terms of the Glasgow Outcome Scale to be used for prevention. However, this study aimed to determine the epidemiology of pedestrian-motor vehicle accidents, the characteristics of head injury, and differences in the Glasgow Outcome Scale in terms of gender. In this retrospective analytical study, the data of 917 eligible injured pedestrians were obtained from the two databases of the Trauma System and the Hospital Information System. The data were analyzed using SPSS software (Version 21). The mean age of all 917 injured pedestrians was 47.55 ± 19.47 years. Most of the injured pedestrians (42.10%) were in the age range of 41-69 years and 81.31% were male. Moreover, 83.07% did not have any acute lesions on the CT scan. The most common brain lesion was brain contusion (n = 33, 3.60%), subarachnoid hemorrhage (n = 33, 3.60%), and skull fracture (n = 29, 3.16%). Among all concurrent injuries, lower extremity/pelvic injuries were observed in 216 patients (23.56%). Outpatient treatment (n = 782, 85.27%), airway control/endotracheal intubation (n = 57, 6.22%), and resuscitation (n = 35, 3.82%) were the most applied treatments respectively. There were significant differences in the Glasgow Outcome Scale between men and women (P- value = 0. 012). The high rate of mortalities, disability, head injuries, contusion, subarachnoid hemorrhage, and skull fractures in pedestrians involved in MVAs emphasizes the need for developing and implementing prevention strategies including appropriate management and risk reduction. Male pedestrians were at higher risk of motor vehicle accidents and worse Glasgow Outcome Scale. The presented data identified the main types of pedestrian injuries and suggested the importance of adopting appropriate preventive strategies to achieve the most effective interventions for creating a safer community.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Pedestrians; Subarachnoid Hemorrhage; Retrospective Studies; Craniocerebral Trauma; Accidents, Traffic; Skull Fractures; Motor Vehicles; Wounds and Injuries
PubMed: 37985796
DOI: 10.1038/s41598-023-47476-z -
Korean Journal of Neurotrauma Oct 2015The importance of traumatic dural venous sinus injury lies in the probability of massive blood loss at the time of trauma or emergency operation resulting in a high...
OBJECTIVE
The importance of traumatic dural venous sinus injury lies in the probability of massive blood loss at the time of trauma or emergency operation resulting in a high mortality rate during the perioperative period. We considered the appropriate methods of treatment that are most essential in the overall management of traumatic dural venous sinus injuries.
METHODS
We conducted a retrospective review of all cases involving patients with dural venous sinus injury who presented to our hospital between January 1999 and December 2014.
RESULTS
Between January 1999 and December 2014, 20 patients with a dural venous sinus injury out of the 1,200 patients with severe head injuries who had been operated upon in our clinic were reviewed retrospectively. There were 17 male and 3 female patients. In 11 out of the 13 patients with a linear skull fracture crossing the dural venous sinus, massive blood loss from the injured sinus wall could be controlled by simple digital pressure using Gelfoam. All 5 patients with a linear skull fracture parallel to the sinus over the venous sinus developed massive sinus bleeding that could not be controlled by simple digital pressure.
CONCLUSION
When there is a linear skull fracture parallel to the sinus over the dural venous sinus or a depressed skull fracture penetrating the sinus, the surgeon should be prepared for the possibility of potentially fatal venous sinus injury, even in the absence of a hematoma.
PubMed: 27169076
DOI: 10.13004/kjnt.2015.11.2.118 -
Radiologia 2019Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with... (Review)
Review
Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with multiple trauma, these injuries can be detected on CT scans of the head and neck, where the direct and indirect signs are usually sufficient to establish the diagnosis. It is important to these fractures because the temporal bone has critical structures and the complexity of this region increases the risk of error unless special care is taken. This article reviews the key anatomical points, the systematization of the imaging findings, and the classifications used for temporal bone fracture. We emphasize the usefulness of identifying and describing the findings in relation to important structures in this region, of looking for unseen fractures suspected through indirect signs, and of identifying anatomical structures that can simulate fractures. We point out that the classical classifications of these fractures are less useful, although they continue to be used for treatment decisions.
Topics: Cochlea; Ear; Ear Canal; Ear Ossicles; Facial Nerve; Facial Nerve Injuries; Humans; Petrous Bone; Skull Fractures; Symptom Assessment; Temporal Bone
PubMed: 30777299
DOI: 10.1016/j.rx.2018.12.005 -
Journal of Cranio-maxillo-facial... Feb 2022The study aimed to investigate whether the incidence rate of external auditory canal (EAC) fracture varies among different clinical types of condylar fracture. A...
The study aimed to investigate whether the incidence rate of external auditory canal (EAC) fracture varies among different clinical types of condylar fracture. A retrospective cohort study was conducted in single hospital of China. Eligible patients diagnosed with mandibular condylar fractures were retrospectively reviewed. Among all patients with condylar fractures (318 cases and 437 sides), 45 cases and 59 sides (59/437 sides, 13.5%) were found with EAC fracture, including 17(17/38, 44.7%) sides of sagittal fracture of condyle (Type I), 21(21/59, 35.6%) sides of intracapsular condylar fracture (Type II), 8 (8/306, 2.6%) sides of condylar neck fracture (Type III), and 6 (6/34, 17.7%) sides of condylar base fracture (Type IV). Type III condylar fracture had a significant lower rate of EAC fracture than all other three types (all p<0.001). Type I condylar fracture had a higher rate of EAC fracture compared to Type IV (p=0.014). The incidence rates of EAC fracture in combined Type I+Type II group (38/97, 39.2%) was significantly higher than Type III (8/306,2.6%, p<0.001) and Type IV (6/34,17.7%, p=0.002). A total of 35 sides (27 patients) with combined fractures were followed up for 6 months after treatment, among whom 11 sides (7 patients) were operated for both fractures simultaneously. Neither EAC stenosis nor hearing loss was observed. Meanwhile, for 24 non-operated ears from 20 patients, all EACs showed different degrees of stenosis. In conclusion, oral and maxillofacial surgeons should pay more attention to EAC fracture combined with condylar fracture, especially for patients diagnosed with condylar head fracture. Maxillofacial fractures should be accompanied by early treatment of EAC fractures, in order to prevent EAC stenosis, hearing loss, and other complications.
Topics: Ear Canal; Fracture Fixation, Internal; Humans; Mandibular Condyle; Mandibular Fractures; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34810109
DOI: 10.1016/j.jcms.2021.11.004