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Children (Basel, Switzerland) May 2024Pediatric basilar skull fractures (BSFs) are a rare type of traumatic head injury that can cause debilitating complications without prompt treatment. Here, we sought to... (Review)
Review
Pediatric basilar skull fractures (BSFs) are a rare type of traumatic head injury that can cause debilitating complications without prompt treatment. Here, we sought to review the literature and characterize the clinical features, management, and outcomes of pediatric BSFs. We identified 21 relevant studies, excluding reviews, meta-analyses, and non-English articles. The incidence of pediatric BSFs ranged from 0.0001% to 7.3%, with falls from multi-level heights and traffic accidents being the primary causes (9/21). The median presentation age ranged from 3.2 to 12.8 years, and the mean age of patients across all studies was 8.68 years. Up to 55% of pediatric BSFs presented with intracranial hematoma/hemorrhage, along with pneumocephalus and edema. Cranial nerve palsies were a common complication (9/21), with the facial nerve injured most frequently (7/21). While delayed cranial nerve palsy was reported in a few studies (4/21), most resolved within three months post-admission. Other complications included CSF leaks (10/21) and meningitis (4/21). Management included IV fluids, antiemetics, and surgery (8/21) to treat the fracture directly, address a CSF leak, or achieve cranial nerve compression. Despite their rarity, pediatric skull base fractures are associated with clinical complications, including CSF leaks and cranial nerve palsies. Given that some of these complications may be delayed, patient education is critical.
PubMed: 38790559
DOI: 10.3390/children11050564 -
Oral Surgery, Oral Medicine, Oral... Jul 2024Naso-orbito-ethmoidal fractures (NOE) fractures are uncommon but critical injuries. This review aims to investigate the patient factors, procedural factors, and... (Review)
Review
OBJECTIVE
Naso-orbito-ethmoidal fractures (NOE) fractures are uncommon but critical injuries. This review aims to investigate the patient factors, procedural factors, and postoperative outcomes associated with the surgical management of NOE fractures.
STUDY DESIGN
PubMed and Scopus databases were systematically searched between 1993 and 2023 using the search strategy "(naso-orbito-ethmoidal OR nasoethmoid OR nasoorbitoethmoidal) AND fracture." Articles reporting clinical studies investigating the surgical management of NOE fractures were included. Articles that were duplicates, non-English, or non-full text; reported an unclear age range; reported insufficient data; and/or reported on a sample size less than 10 were excluded. Data on patient factors, procedural factors, and postoperative outcomes were extracted.
RESULTS
Of the 412 articles identified, 6 eligible articles (retrospective case series) representing 95 adult cases and 84 pediatric cases were included. The mean ages were 29.0 and 10.2 years, respectively. Most cases were male (65.3%; 73.9%). Motor vehicle accidents were the most common mechanism of injury (79.2% and 50.0%, respectively). Coronal incision was the most common approach. Epiphora (n = 33) and scar problems (n = 21) were the most common complications in adult and pediatric cases, respectively.
CONCLUSIONS
Further robust longitudinal studies with a clear description of fracture classification and surgical timing would be helpful. Gaps in knowledge include concomitant injuries, digitally-assisted applications, and risk factors for adverse outcomes.
Topics: Humans; Orbital Fractures; Ethmoid Bone; Skull Fractures; Nasal Bone
PubMed: 38697897
DOI: 10.1016/j.oooo.2024.02.021 -
Cureus Jan 2024Point-of-care ultrasound (POCUS) is an imaging modality that has become a fundamental part of clinical care provided in the emergency department (ED). The applications... (Review)
Review
Point-of-care ultrasound (POCUS) is an imaging modality that has become a fundamental part of clinical care provided in the emergency department (ED). The applications of this tool in the ED have ranged from resuscitation, diagnosis, and therapeutic to procedure guidance. This review aims to summarize the evidence on the use of POCUS for diagnosis and procedure guidance. To achieve this, CrossRef, PubMed, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched for studies published between January 2000 and November 2023. Additionally, the risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 (for studies on the diagnostic role of POCUS) and Cochrane Risk of Bias tool (for studies on the use of POCUS for procedure guidance). Furthermore, diagnostic accuracy outcomes were pooled using STATA 16 software (StatCorp., College Station, TX, USA), while outcomes related to procedure guidance were pooled using the Review Manager software. The study included 81 articles (74 evaluating the diagnostic application of POCUS and seven evaluating the use of POCUS in guiding clinical procedures). In our findings sensitivities and specificities for various conditions were as follows: appendicitis, 65% and 89%; hydronephrosis, 82% and 74%; small bowel obstruction, 93% and 82%; cholecystitis, 75% and 96%; retinal detachment, 94% and 91%; abscess, 95% and 85%; foreign bodies, 67% and 97%; clavicle fractures, 93% and 94%; distal forearm fractures, 97% and 94%; metacarpal fractures, 94% and 92%; skull fractures, 91% and 97%; and pleural effusion, 91% and 97%. A subgroup analysis of data from 11 studies also showed that the two-point POCUS has a sensitivity and specificity of 89% and 96%, while the three-point POCUS is 87% sensitive and 92% specific in the diagnosis of deep vein thrombosis. In addition, the analyses showed that ultrasound guidance significantly increases the overall success rate of peripheral venous access (p = 0.02) and significantly reduces the number of skin punctures (p = 0.01) compared to conventional methods. In conclusion, POCUS can be used in the ED to diagnose a wide range of clinical conditions accurately. Furthermore, it can be used to guide peripheral venous access and central venous catheter insertion.
PubMed: 38694948
DOI: 10.7759/cureus.52371 -
Emergency Radiology Jun 2024Ultrasonography, a radiation-free and cost-effective modality, stands out as a promising tool for evaluating nasal bone fractures. Despite limited literature on its... (Meta-Analysis)
Meta-Analysis
Ultrasonography, a radiation-free and cost-effective modality, stands out as a promising tool for evaluating nasal bone fractures. Despite limited literature on its pediatric application, there is an increasing recognition of its potential to enhance diagnostic precision. To evaluate the diagnostic efficacy of ultrasound in detecting pediatric nasal bone fractures. Employing established guidelines, a systematic review and meta-analysis were conducted through a comprehensive literature search in PubMed, Scopus, Web of Science, and Embase databases until December 5, 2023. Inclusion criteria encompassed studies reporting diagnostic accuracy measures of ultrasound in pediatric patients with nasal bone fractures. Data extraction and analysis were undertaken for the selected studies. Involving four studies with 277 patients, ultrasound demonstrated a pooled sensitivity of 66.1% (95% CI: 35.1-87.5%) and specificity of 86.8% (95% CI: 80.1-91.4%) in diagnosing pediatric nasal fractures. The area under the receiver operating characteristic curve (AUC) was 0.88 (95% CI: 0.72-0.93). After excluding an outlier study, sensitivity and specificity increased to 78.0% (95% CI: 65.6-86.9%) and 87.8 (95% CI: 78.1-93.6%), respectively, with an AUC of 0.79 (95% CI: 0.75-0.94). Pooled positive and negative likelihood ratios were 5.11 (95% CI: 2.12-9.15) and 0.40 (95% CI: 0.14-0.77) before exclusion and 6.75 (95% CI: 3.47-12.30) and 0.26 (95% CI: 0.15-0.40) after exclusion of an outlier study, respectively. This study highlighted ultrasonography's utility in diagnosing pediatric nasal bone fractures with high accuracy and specificity. However, caution is advised in relying solely on ultrasound due to suboptimal overall diagnostic performance, evident in likelihood ratios.
Topics: Child; Humans; Nasal Bone; Sensitivity and Specificity; Skull Fractures; Ultrasonography
PubMed: 38538882
DOI: 10.1007/s10140-024-02225-1 -
Scientific Reports Mar 2024The hemorrhagic progression of a contusion (HPC) after Traumatic brain injury (TBI) is one of the important causes of death in trauma patients. The purpose of this... (Meta-Analysis)
Meta-Analysis
The hemorrhagic progression of a contusion (HPC) after Traumatic brain injury (TBI) is one of the important causes of death in trauma patients. The purpose of this meta-analysis was to evaluate the predictive effect of imaging features of Computed tomography (CT) on HPC after TBI. A comprehensive systematic search was performed using PubMed, EMBASE, and WEB OF SCIENCE databases to identify all relevant literature. A total of 8 studies involving 2543 patients were included in this meta-analysis. Meta-analysis showed that subarachnoid hemorrhage (OR 3.28; 95% CI 2.57-4.20), subdural hemorrhage (OR 4.35; 95% CI 3.29-5.75), epidural hemorrhage (OR 1.47;95% CI 1.15-1.89), contrast extravasation (OR 11.81; 95% CI 4.86-28.71) had a predictive effect on the occurrence of HPC. Skull fracture (OR 1.64; 95% CI 0.84-3.19) showed no statistical significance, and midline displacement > 5 mm (OR 4.66; 95% CI 1.87-11.62) showed high heterogeneity. The results of this meta-analysis showed that some imaging features were effective predictors of HPC after TBI. Well-designed prospective studies are needed to more accurately assess the effective predictors of HPC after TBI.
Topics: Humans; Brain Injuries, Traumatic; Contusions; Tomography, X-Ray Computed; Subarachnoid Hemorrhage; Hematoma, Subdural
PubMed: 38472247
DOI: 10.1038/s41598-024-56232-w -
BMJ Open Feb 2024Hospital-based clinical decision tools support clinician decision-making when a child presents to the emergency department with a head injury, particularly regarding CT...
Which elements of hospital-based clinical decision support tools for the assessment and management of children with head injury can be adapted for use by paramedics in prehospital care? A systematic mapping review and narrative synthesis.
OBJECTIVE
Hospital-based clinical decision tools support clinician decision-making when a child presents to the emergency department with a head injury, particularly regarding CT scanning. However, there is no decision tool to support prehospital clinicians in deciding which head-injured children can safely remain at scene. This study aims to identify clinical decision tools, or constituent elements, which may be adapted for use in prehospital care.
DESIGN
Systematic mapping review and narrative synthesis.
DATA SOURCES
Searches were conducted using MEDLINE, EMBASE, PsycINFO, CINAHL and AMED.
ELIGIBILITY CRITERIA
Quantitative, qualitative, mixed-methods or systematic review research that included a clinical decision support tool for assessing and managing children with head injury.
DATA EXTRACTION AND SYNTHESIS
We systematically identified all in-hospital clinical decision support tools and extracted from these the clinical criteria used in decision-making. We complemented this with a narrative synthesis.
RESULTS
Following de-duplication, 887 articles were identified. After screening titles and abstracts, 710 articles were excluded, leaving 177 full-text articles. Of these, 95 were excluded, yielding 82 studies. A further 14 studies were identified in the literature after cross-checking, totalling 96 analysed studies. 25 relevant in-hospital clinical decision tools were identified, encompassing 67 different clinical criteria, which were grouped into 18 categories.
CONCLUSION
Factors that should be considered for use in a clinical decision tool designed to support paramedics in the assessment and management of children with head injury are: signs of skull fracture; a large, boggy or non-frontal scalp haematoma neurological deficit; Glasgow Coma Score less than 15; prolonged or worsening headache; prolonged loss of consciousness; post-traumatic seizure; amnesia in older children; non-accidental injury; drug or alcohol use; and less than 1 year old. Clinical criteria that require further investigation include mechanism of injury, clotting impairment/anticoagulation, vertigo, length of time of unconsciousness and number of vomits.
Topics: Child; Humans; Infant; Paramedics; Decision Support Systems, Clinical; Craniocerebral Trauma; Hospitals; Emergency Medical Services
PubMed: 38355171
DOI: 10.1136/bmjopen-2023-078363 -
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 -
F1000Research 2023Our study aims to estimate the prevalence of Frey syndrome following open reduction and internal fixation (ORIF) for mandibular fractures. Two reviewers independently... (Meta-Analysis)
Meta-Analysis
Our study aims to estimate the prevalence of Frey syndrome following open reduction and internal fixation (ORIF) for mandibular fractures. Two reviewers independently conducted a systematic literature search in the Medline and Scopus databases. The pooled prevalence with 95% confidence intervals (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed. In total, fifteen eligible studies were included in this meta-analysis. One study was identified as critically influential. The overall prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures was estimated as 0.01% (95%CI 0%-0.7%) with moderate heterogeneity observed between studies. In the meta-regression analysis with continuous variables, no statistically significant association was observed. Despite the relatively low prevalence, the impact of Frey syndrome on affected individuals should not be underestimated. Additional research will provide a more comprehensive understanding of the underlying factors contributing to Frey syndrome, leading to improved preventive measures and treatment strategies. A better grasp of the prevalence and associated risk factors will aid in the development of guidelines to minimize the occurrence of this syndrome.
Topics: Humans; Fracture Fixation, Internal; Mandibular Fractures; Sweating, Gustatory; Prevalence; Risk Factors
PubMed: 38106653
DOI: 10.12688/f1000research.140994.2 -
Journal of Stomatology, Oral and... Jun 2024This systematic review and meta-analysis aimed to review the recent literature on the technical accuracy of surgical navigation for patient-specific reconstruction of... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis aimed to review the recent literature on the technical accuracy of surgical navigation for patient-specific reconstruction of orbital fractures using a patient-specific implant, and to compare surgical navigation with conventional techniques.
MATERIALS AND METHODS
A systematic literature search was conducted in PubMed (Medline), Embase, Web of Science, and Cochrane (Core Collection) databases on May 16, 2023. Literature comparing surgical navigation with a conventional method using postoperative three-dimensional computed tomography imaging was collected. Only articles that studied at least one of the following outcomes were included: technical accuracy (angular accuracy, linear accuracy, volumetric accuracy, and degree of enophthalmos), preoperative and perioperative times, need for revision, complications, and total cost of the intervention. MINORS criteria were used to evaluate the quality of the articles.
RESULTS
After screening 3733 articles, 696 patients from 27 studies were included. A meta-analysis was conducted to evaluate volumetric accuracy and revision rates. Meta-analysis proved a significant better volumetric accuracy (0.93 cm ± 0.47 cm) when surgical navigation was used compared with conventional surgery (2.17 cm ± 1.35 cm). No meta-analysis of linear accuracy, angular accuracy, or enophthalmos was possible due to methodological heterogeneity. Surgical navigation had a revision rate of 4.9%, which was significantly lower than that of the conventional surgery (17%). Costs were increased when surgical navigation was used.
CONCLUSION
Studies with higher MINORS scores demonstrated enhanced volumetric precision compared with traditional approaches. Surgical navigation has proven effective in reducing revision rates compared to conventional approaches, despite increased costs.
Topics: Humans; Orbital Fractures; Surgery, Computer-Assisted; Plastic Surgery Procedures; Tomography, X-Ray Computed; Imaging, Three-Dimensional
PubMed: 37951500
DOI: 10.1016/j.jormas.2023.101683 -
PloS One 2023The aim of this META-analysis was to evaluate the efficacy of photobiomodulation (PBM) therapy in the treatment of inferior alveolar nerve (IAN) injury due to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this META-analysis was to evaluate the efficacy of photobiomodulation (PBM) therapy in the treatment of inferior alveolar nerve (IAN) injury due to orthognathic surgeries, extraction of impacted third molars and mandibular fractures.
METHODS AND MATERIALS
A electric search was conducted by a combination of manual search and four electric databases including Pubmed, Embase, Cochrane library and Web of Science, with no limitation on language and publication date. Gray literature was searched in ClinicalTrials.gov and googlescholar. All retrieved articles were imported into ENDNOTE software (version X9) and screened by two independent reviewers. All analysis was performed using the REVMAN software (version 5.3).
RESULTS
Finally, 15 randomized controlled trials met the inclusion criteria for qualitative analysis and 14 for META-analysis from 219 articles. The results showed that PBM therapy had no effect on nerve injury in a short period of time (0-48h, 14 days), but had significant effect over 30 days. However, the effect of photobiomodulation therapy on thermal discrimination was still controversial, most authors supported no significant improvement. By calculating the effective rate of PBM, it was found that there was no significant difference in the onset time of treatment, whether within or over 6 months.
CONCLUSIONS
The results of this META-analysis show that PBM therapy is effective in the treatment of IAN injures no matter it begins early or later. However, due to the limited number of well-designed RCTs and small number of patients in each study, it would be necessary to conduct randomized controlled trials with large sample size, long follow-up time and more standardized treatment and evaluation methods in the future to provide more accurate and clinically meaningful results.
Topics: Humans; Low-Level Light Therapy; Tooth Extraction; Mandibular Nerve; Mandibular Fractures
PubMed: 37561792
DOI: 10.1371/journal.pone.0287833