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Pediatric Radiology Aug 2018Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history,... (Review)
Review
Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature.
Topics: Child; Child Abuse; Child, Preschool; Consensus; Craniocerebral Trauma; Hematoma, Subdural; Humans; Infant; Infant, Newborn; Retinal Hemorrhage; Rib Fractures; Societies, Medical; Spinal Injuries
PubMed: 29796797
DOI: 10.1007/s00247-018-4149-1 -
Deutsches Arzteblatt International Oct 2018The conservative treatment of traumatic thoracolumbar vertebral fractures is often not clearly defined. (Review)
Review
BACKGROUND
The conservative treatment of traumatic thoracolumbar vertebral fractures is often not clearly defined.
METHODS
This review is based on articles retrieved by a systematic search in the PubMed and Web of Science databases for publications up to February 2018 dealing with the conservative treatment of traumatic thoracolumbar vertebral fractures. The search initially yielded 3345 hits, of which 35 were suitable for use in this review.
RESULTS
It can be concluded from the available original clinical research on the subject, including three randomized controlled trials (RCTs), that the primary diagnostic evaluation should be with plain x-rays, in the standing position if possible. If a fracture is suspected on the plain films, computed tomography (CT) is indicated. Magnetic resonance imaging (MRI) is additionally advisable if there is a burst fracture. The spinal deformity resulting from the fracture should be quantified in terms of the Cobb angle. The choice of a conservative or operative treatment strategy is based on the primary stability of the fracture, the degree of deformity, the presence or absence of disc injury, and the patient's clinical state. Our analysis of the three RCTs implies that early functional therapy without a corset should be performed, although treatment in a corset may be appropriate to control pain. Follow-up x-rays should be obtained after mobilization and at one week, three weeks, six weeks, and twelve weeks.
CONCLUSION
Further comparative studies of the indications for surgery and specific conservative treatment modalities would be desirable.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Conservative Treatment; Female; Germany; Humans; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Radiography; Spinal Fractures; Thoracic Injuries; Wounds and Injuries
PubMed: 30479250
DOI: 10.3238/arztebl.2018.0697 -
Radiologia Mar 2023Cervical spine trauma encompasses a wide of injuries, ranging from stable, minor lesions to unstable, complex lesions that can lead to neurologic sequelae or vascular...
Cervical spine trauma encompasses a wide of injuries, ranging from stable, minor lesions to unstable, complex lesions that can lead to neurologic sequelae or vascular involvement. The Canadian C-Spine Rule and the NEXUS criteria aim to identify individuals with a low risk of cervical spine trauma who can safely forgo imaging tests. In high-risk patients, an imaging test is indicated. In adult patients the imaging test of choice is multidetector computed tomography. Complementary imaging tests such as CT angiography of the supra-aortic vessels and/or magnetic resonance imaging are occasionally necessary. It can be challenging for radiologists to diagnose and classify these lesions, because some of them can be subtle and difficult to detect. This paper aims to describe the most important imaging findings and the most widely used classification systems.
Topics: Adult; Humans; Canada; Spinal Injuries; Magnetic Resonance Imaging; Cervical Vertebrae; Multidetector Computed Tomography
PubMed: 37024227
DOI: 10.1016/j.rxeng.2022.10.012 -
La Radiologia Medica Jan 2023Spinal trauma is an important cause of disability worldwide. Injury to the cervical spine (CS) occurs frequently after major trauma. 5-10% of patients with blunt trauma... (Review)
Review
Spinal trauma is an important cause of disability worldwide. Injury to the cervical spine (CS) occurs frequently after major trauma. 5-10% of patients with blunt trauma have a cervical spine injury. The cervical spine accounts for ~ 50% of all spinal injuries. Determination of CS stability is a common challenge in the acute care setting of patients with trauma. Several issues, indeed, are of particular concern: who needs CS imaging; what imaging should be obtained; when should computed tomography (CT), magnetic resonance imaging (MRI), or flexion/extension (F/E) radiographs be obtained; and how is significant ligamentous injury excluded in the comatose patient. CT and MRI both have roles to play. This article aims to present the different imaging to frame techniques to be used with greater precision in the acute event also for the purpose of planning the next therapeutic process. An overview of the applicability of the same methods in forensic pathology is also provided highlighting possible future biomarker to ease in diagnosis of acute TBI.
Topics: Humans; Spinal Injuries; Tomography, X-Ray Computed; Radiography; Magnetic Resonance Imaging; Wounds, Nonpenetrating; Cervical Vertebrae
PubMed: 36719553
DOI: 10.1007/s11547-022-01578-2 -
Clinical Orthopaedics and Related... May 2017
Topics: Humans; Societies, Medical; Spinal Cord Injuries; Spinal Injuries; Symptom Assessment; Trauma Severity Indices; United States
PubMed: 27815685
DOI: 10.1007/s11999-016-5133-4 -
Magnetic Resonance Imaging Clinics of... Aug 2022This article is devoted to the MR imaging evaluation of spine emergencies, defined as spinal pathologic conditions that pose an immediate risk of significant morbidity... (Review)
Review
This article is devoted to the MR imaging evaluation of spine emergencies, defined as spinal pathologic conditions that pose an immediate risk of significant morbidity or mortality to the patient if not diagnosed and treated in a timely manner. MR imaging plays a central role in the timely diagnosis of spine emergencies. A summary of MR imaging indications and MR imaging protocols tailored for a variety of spinal emergencies will be presented followed by a review of key imaging findings for the most-encountered emergent spine pathologic conditions. Pathologic conditions will be broadly grouped into traumatic and atraumatic pathologic conditions. For traumatic injuries, a practical and algorithmic diagnostic approach based on the AO Spine injury classification system will be presented focused on subaxial spine trauma. Atraumatic spinal emergencies will be dichotomized into compressive and noncompressive subtypes. The location of external compressive disease with respect to the thecal sac is fundamental to establishing a differential diagnosis for compressive emergencies, whereas specific patterns of spinal cord involvement on MR imaging will guide the discussion of inflammatory and noninflammatory causes of noncompressive myelopathy.
Topics: Emergencies; Humans; Magnetic Resonance Imaging; Spinal Diseases; Spinal Injuries; Spine
PubMed: 35995469
DOI: 10.1016/j.mric.2022.04.004 -
Chinese Journal of Traumatology =... Aug 2020Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against... (Review)
Review
Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Cross Infection; Emergency Service, Hospital; Humans; Pandemics; Patient Care Team; Pneumonia, Viral; Practice Guidelines as Topic; SARS-CoV-2; Spinal Injuries; Transportation of Patients
PubMed: 32674856
DOI: 10.1016/j.cjtee.2020.06.003 -
European Journal of Trauma and... Oct 2019Paediatric cervical spine injuries are fortunately a rare entity. However, they do have the potential for devastating neurological sequelae with lifelong impact on the... (Review)
Review
PURPOSE
Paediatric cervical spine injuries are fortunately a rare entity. However, they do have the potential for devastating neurological sequelae with lifelong impact on the patient and their family. Thus, management ought to be exceptional from the initial evaluation at the scene of the injury, through to definitive management and rehabilitation.
METHODS
We set out to review cervical spine injuries in children and advise on current best practice with regards to management.
RESULTS
Epidemiology, initial management at the scene of injury, radiological findings and pitfalls of cervical spine trauma are outlined. Strategies for conservative and surgical management are detailed depending on the pattern of injury. The management of spinal cord injuries without radiological abnormality (SCIWORA) and cranio-cervical arterial injuries is also reviewed.
CONCLUSIONS
Due to a paucity of evidence in these rare conditions, expert opinion is necessary to guide best practice management and to ensure the best chance of a good outcome for the injured child.
Topics: Cervical Vertebrae; Child; Child, Preschool; Emergency Medical Services; Guideline Adherence; Humans; Immobilization; Injury Severity Score; Prospective Studies; Radiography; Spinal Cord Injuries; Spinal Injuries; Time-to-Treatment; Transportation of Patients
PubMed: 30167742
DOI: 10.1007/s00068-018-0992-x -
Scientific Reports Jan 2022The aim of the study was to recognise what participant-, training- and post-injury-related factors are associated with an injury and re-injury occurrence in female pole...
The aim of the study was to recognise what participant-, training- and post-injury-related factors are associated with an injury and re-injury occurrence in female pole dancers (PDs). 320 female PDs fulfilled a custom survey. 1050 injuries were reported by 276 PDs, 59% of injuries were related to lower extremity, 39% to upper extremity and 10% to spine and trunk. 156 PDs reported sustaining a re-injury, and overall, 628 re-injuries were reported. The median weekly pole-specific training session volume was 90 min and 240 min in the low and high qualified group, respectively. The total training volume was 180 min in the low qualified PDs and 240 min in the high qualified group. PDs with higher height and spending more time on pole-specific training in studio and on other forms of training have higher odds of sustaining an injury. PDs with lower level of experience in training, who sustained an injury, and who had a shorter pause between the moment of injury and the return to performance, and thus who did not fully recover, have higher odds of sustaining a re-injury. Sport-specific injury prevention strategies should be developed and implemented in this cohort, since over 85% of pole dancers reported sustaining some kind of injury.
Topics: Adult; Athletic Injuries; Cohort Studies; Dancing; Female; Humans; Logistic Models; Lower Extremity; Reinjuries; Risk Factors; Spinal Injuries; Surveys and Questionnaires; Upper Extremity; Young Adult
PubMed: 34997040
DOI: 10.1038/s41598-021-04000-5 -
BMC Musculoskeletal Disorders May 2023Thoracolumbar spine injury (TLSI) is a major concern worldwide despite its low prevalence. Studies demonstrate a gradual rise in annual incidence. There have been...
BACKGROUND
Thoracolumbar spine injury (TLSI) is a major concern worldwide despite its low prevalence. Studies demonstrate a gradual rise in annual incidence. There have been improvements in its management. However, a lot is still to be done. TLSI secondary to trauma usually occurs abruptly and leaves demeaning consequences, especially in our setting where the prognosis from several studies is poor. This study aimed to describe the etiology, management principles, and prognosis of TLSI in Douala General Hospital and as such contribute data on those aspects in the research community.
METHOD
This was a hospital-based five-year retrospective study. The study population was patients treated for TLSI in the Douala General Hospital from January 2014 to December 2018. Patients' medical records were used to retrieve data. Data analysis was done using SPSS Version 23. Logistic regression models were fitted to assess the association between dependent and independent variables. Statistical significance was set at 95% CI, with a P-value < 0.05.
RESULTS
We studied a total of 70 patients' files including 56 males. The mean age of occurrence of TLSI was 37.59 ± 14.07 years. The most common etiology was road traffic accidents (45.7%) and falls (30.0%). Half of our patients (n = 35) had an incomplete neurological deficit (Frankel B - D). Paraplegia was the most common motor deficit (42.9%). The lumbar spine was affected in 55.7% of cases. The most common CT scan finding was fracture of the vertebrae (30%) while the most reported MRI finding was disc herniation with contusion (38.5%). More than half (51.4%) of our patients were referred from peripheral health centers. The median arrival time was 48 h (IQR: 18-144) with 22.9% reporting after a week post-injury. Less than half (48.1%) benefited from surgery, and 41.4% of our population benefited from in-hospital rehabilitation. The median in-hospital delay time for surgery was 120 h (IQR: 66-192). While the median time between injury and surgery was 188 h (IQR: 144-347). The mortality rate was 5.7% (n = 4). Almost all (86.9%) of the patients developed complications and we had a 61.4% improvement in neurological status upon discharge. Being covered by health insurance was a predictor of improved neurological status (AOR = 15.04, 95%CI:2.90-78.20, P = 0.001) while being referred was a predictor of a stationary neurological status upon discharge (AOR = 0.12, 95%CI:0.03-0.52, P = 0.005). The average hospital stay was 20 days. We did not identify any predictors of lengthy hospital stay.
CONCLUSION
Road traffic accident is the most common etiology of TLSI. The arrival time to a neurosurgery specialized center after a traumatic injury, and the in-hospital delay time for surgery is high. Reduction of these delays, encouraging universal health insurance coverage, and improving on management to reduce complications would better the outcome of TLSI which is comparable with those in other studies.
Topics: Male; Humans; Young Adult; Adult; Middle Aged; Retrospective Studies; Cameroon; Spinal Injuries; Paraplegia; Lumbar Vertebrae
PubMed: 37189065
DOI: 10.1186/s12891-023-06481-z