-
Korean Journal of Radiology Mar 2022To develop and evaluate a deep learning-based artificial intelligence (AI) model for detecting skull fractures on plain radiographs in children.
OBJECTIVE
To develop and evaluate a deep learning-based artificial intelligence (AI) model for detecting skull fractures on plain radiographs in children.
MATERIALS AND METHODS
This retrospective multi-center study consisted of a development dataset acquired from two hospitals (n = 149 and 264) and an external test set (n = 95) from a third hospital. Datasets included children with head trauma who underwent both skull radiography and cranial computed tomography (CT). The development dataset was split into training, tuning, and internal test sets in a ratio of 7:1:2. The reference standard for skull fracture was cranial CT. Two radiology residents, a pediatric radiologist, and two emergency physicians participated in a two-session observer study on an external test set with and without AI assistance. We obtained the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity along with their 95% confidence intervals (CIs).
RESULTS
The AI model showed an AUROC of 0.922 (95% CI, 0.842-0.969) in the internal test set and 0.870 (95% CI, 0.785-0.930) in the external test set. The model had a sensitivity of 81.1% (95% CI, 64.8%-92.0%) and specificity of 91.3% (95% CI, 79.2%-97.6%) for the internal test set and 78.9% (95% CI, 54.4%-93.9%) and 88.2% (95% CI, 78.7%-94.4%), respectively, for the external test set. With the model's assistance, significant AUROC improvement was observed in radiology residents (pooled results) and emergency physicians (pooled results) with the difference from reading without AI assistance of 0.094 (95% CI, 0.020-0.168; = 0.012) and 0.069 (95% CI, 0.002-0.136; = 0.043), respectively, but not in the pediatric radiologist with the difference of 0.008 (95% CI, -0.074-0.090; = 0.850).
CONCLUSION
A deep learning-based AI model improved the performance of inexperienced radiologists and emergency physicians in diagnosing pediatric skull fractures on plain radiographs.
Topics: Artificial Intelligence; Child; Deep Learning; Humans; Radiographic Image Interpretation, Computer-Assisted; Radiography; Retrospective Studies; Sensitivity and Specificity; Skull; Skull Fractures
PubMed: 35029078
DOI: 10.3348/kjr.2021.0449 -
International Journal of Pediatric... Nov 2022Multi-level fall (MLF) accounts for 26.5%-37.7% of traumatic pediatric basilar skull fractures (BSFs). There is a dearth of information concerning recommendations for...
OBJECTIVE
Multi-level fall (MLF) accounts for 26.5%-37.7% of traumatic pediatric basilar skull fractures (BSFs). There is a dearth of information concerning recommendations for work-up, diagnosis, treatment, and otolaryngological follow-up of pediatric basilar skull fractures secondary to MLFs. Through a systematic literature review and retrospective review of an institution's trauma experience, we sought to identify clinical findings among pediatric MLF patients that indicate the need for otolaryngological follow-up.
METHODS
A two-researcher team following the PRISMA guidelines performed a systematic literature review. PubMed, Web of Science, and EBSCO databases were searched August 16th 2020 and again on November 20th 2021 for English language articles published after 1980 using search terms Pediatric AND (fall OR "multi level fall" OR "fall from height") AND ("basilar fracture" OR "basilar skull fracture" OR "skull base fracture" OR "skull fracture"). Simultaneously, an institutional trauma database and retrospective chart review was performed for all patients under age 18 who presented with a MLF to a pediatric tertiary care center between 2007 and 2018.
RESULTS
168 publications were identified and 13 articles reporting pediatric basilar skull fracture data and MLF as a mechanism of injury were selected for review. MLF is the most common etiology of BSF, accounting for 26.5-37.7% of pediatric BSFs. In the retrospective review, there were 180 cases of BSF from MLF in the study period (4.2%). BSF and fall height were significantly associated (p < 0.001), as well as presence of a CSF leak and fall height (p = 0.02), intracranial hemorrhage (ICH) (p = 0.047), and BSF fracture type (p < 0.001). However, when stratified by age, these associations were only present in the younger group. Of those with non-temporal bone BSFs (n = 71), children with hemotympanum (n = 7) were approximately 18 times more likely (RR 18.3, 95% CI 1.89 to 177.02) than children without hemotympanum (n = 64) to have hearing loss at presentation (28.6% vs. 1.6% of patients).
CONCLUSIONS
MLF is the most common cause of pediatric basilar skull fractures. However, there is limited information on the appropriate work-up or otolaryngologic follow-up for this mechanism of injury. Our retrospective review suggests fall height is predictive for BSF, ICH, and CSF leak in younger children. Also, children with non-temporal bone BSFs and hemotympanum may represent a significant population requiring otolaryngology follow-up.
Topics: Adolescent; Child; Humans; Retrospective Studies; Skull; Skull Fractures
PubMed: 36030630
DOI: 10.1016/j.ijporl.2022.111291 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Mar 2024Traumatic head injuries (THIs) are one of the major causes of death in forensic cases. The aim of this study was to investigate the characteristics of patients with...
BACKGROUND
Traumatic head injuries (THIs) are one of the major causes of death in forensic cases. The aim of this study was to investigate the characteristics of patients with fatal THIs.
METHODS
In this study, a total of 311 patients with fatal THIs, who underwent postmortem examinations and/or autopsies, were retrospectively analyzed. Cases were evaluated based on sex, age group, incident origin, cause of the incident, presence of skull fracture, type of fractured bone (if any), fracture localization and pattern, presence and type of intracranial lesion (if any), and cause of death.
RESULTS
Out of the patients, 242 (77.8%) were male and 69 (22.2%) were female. Accidents accounted for 235 (75.6%) of the incidents, with in-vehicle traffic accidents causing 117 (37.6%). In 221 cases (71.1%), intracranial lesions and skull fractures were observed together. The most common fractures were base fractures (171 cases) and temporal bone fractures (153 cases). The rate of intracranial hemorrhage was lower in the adult age group (69.7%) compared to the older age group (92.6%).
CONCLUSION
The results obtained in this study indicate that the cause of the incident, type of fracture, presence of skull base fracture, and multiple skull fractures increase the likelihood of fatalities. The occurrence of skull fractures reduces intracranial pressure, thereby decreasing the incidence of intracranial lesions. The development and effective enforcement of road traffic safety policies and regulations will reduce the incidence of fatalities.
Topics: Adult; Humans; Male; Female; Aged; Retrospective Studies; Craniocerebral Trauma; Skull Fractures; Incidence; Autopsy; Accidents, Traffic
PubMed: 38506383
DOI: 10.14744/tjtes.2024.32463 -
Chinese Journal of Traumatology =... Oct 2019A head injury (HI) may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture (SBF) is a linear fracture...
PURPOSE
A head injury (HI) may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture (SBF) is a linear fracture at the base of the skull. Loss of consciousness and Glasgow coma score (GCS) may vary depending on an associated intracranial pathology. The pathomechanism is believed to be caused by high energy impact directly to the mastoid and supraorbital bone or indirectly from the cranial vault. Aim of this study is to define the correlation between SBF and intracranial hemorrhage (ICH) in patients with HI.
METHODS
Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to diagnostic criteria of SBF patients based only on clinical symptoms associated with ICH caused by HI treated in the Department of Neurosurgery at Dr. Hasan Sadikin Hospital, Bandung, Indonesia from January 1, 2012 to December 31, 2017. The exclusion criteria included age less than 15 years and no head computed tomography (CT) scan examination provided.
RESULTS
A total of 9006 patients were included into this study in which they were divided into 3 groups: group 1, HI with no ICH; group 2, HI with single ICH and group 3, HI with multiple ICH. In all the SBF cases, SBF at anterior fossa accounted for 69.40% of them, which were mostly accompanied with mild HI (64.70%). Severity of HI and site of SBF correlated with the existence of traumatic brain lesions on CT scan, thus these factors were able to predict whether there were traumatic brain lesions or not. Most of the patients with epidural hemorrhage (EDH) has single traumatic lesion on CT scan, whereas most of the patients with cerebral contusion (CC) has multiple traumatic lesions on CT scan. On patients with both traumatic brain injury and SBF, most of the patients with anterior fossa SBF has EDH; whereas most of the patients with middle fossa SBF were accompanied with CC. Surgery was not required for most of the patients with SBF.
CONCLUSION
SBFs were strongly correlated with traumatic ICH lesions patients with anterior fossa SBF were more likely to suffer EDH whereas with middle fossa SBF were more likely to suffer CC.
Topics: Adult; Brain Injuries, Traumatic; Craniocerebral Trauma; Female; Humans; Incidence; Intracranial Hemorrhages; Male; Retrospective Studies; Skull Base; Skull Fractures
PubMed: 31521457
DOI: 10.1016/j.cjtee.2019.05.006 -
Ear, Nose, & Throat Journal Dec 2020Growing skull fracture (GSF) is an uncommon post-traumatic complication, which accounts for approximately 0.05% to 1% of all skull fractures. Delayed diagnosis of GSF in... (Review)
Review
Growing skull fracture (GSF) is an uncommon post-traumatic complication, which accounts for approximately 0.05% to 1% of all skull fractures. Delayed diagnosis of GSF in adulthood is rare and often involved with a variety of neurological symptoms. Here, we reported an adult patient, with an interval of 17 years from initial head trauma to first diagnosis of GSF. The patient complained of short periods of fainting and bilateral visual hallucinations, with a hard palpable bulge around his right occipitomastoid suture region. Computed tomographic imaging demonstrated an arachnoid cyst extending into right mastoid cavity. Consequently, the delayed diagnosis of GSF was confirmed, and the patient was managed with duroplasty and cranioplasty. At the 8-month follow-up, the patient showed an uneventful postoperative recovery. A comprehensive literature review was also conducted, and a total of 70 GSF cases were identified and summarized. According to the literature review, patients with GSF generally have a history of head trauma in their childhood, and delayed diagnosis is a common situation. Diagnosis of GSF should include complete retrospective medical history, physical, and imaging examinations. Once the diagnosis is confirmed, cranioplasty accompanied with duroplasty might be the most effective way to relieve symptoms and prevent further damage.
Topics: Arachnoid Cysts; Child, Preschool; Craniotomy; Delayed Diagnosis; Hallucinations; Humans; Male; Medical Illustration; Skull Fractures; Syncope; Young Adult
PubMed: 32207331
DOI: 10.1177/0145561320914774 -
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 -
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 -
International Journal of Legal Medicine Nov 2021A tympanal bone fracture is an uncommon complication of head trauma and is mostly associated with a mandibular or petrous bone fracture. Upon reviewing the medicolegal... (Observational Study)
Observational Study
A tympanal bone fracture is an uncommon complication of head trauma and is mostly associated with a mandibular or petrous bone fracture. Upon reviewing the medicolegal literature, we could not find any publications on this topic. Tympanal bone fracture may lead to chronic complications (including external auditory canal stenosis and conductive hearing loss), with an important impact in both the medical and judiciary fields (e.g., chronic disabilities with loss of income). We decided to investigate the prevalence and mechanisms of tympanal bone fractures by means of a retrospective observational study on living victims who underwent head computed tomography after blunt head trauma and clinical forensic investigation at our center. We selected 159 cases of living victims with blunt head trauma (following an assault, traffic accident, or work accident) between January 2016 and December 2020. Re-examination of head imaging revealed 12 cases of tympanal bone fracture. Seven individuals showed cranial fractures involving the petrous bone (on the same side as the tympanal bone fracture). Three individuals had a temporomandibular fracture after a fall with chin impact. Only two victims exhibited an isolated tympanal bone fracture.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Head Injuries, Closed; Humans; Male; Middle Aged; Retrospective Studies; Skull Fractures; Switzerland; Temporal Bone; Tomography, X-Ray Computed; Young Adult
PubMed: 34599364
DOI: 10.1007/s00414-021-02682-0 -
Ear, Nose, & Throat Journal May 2022Nasal bone fracture is a frequent entity consulted to the otolaryngologists, approximately accounting for 39% of all facial bone fractures. The most frequent mechanisms...
OBJECTIVES
Nasal bone fracture is a frequent entity consulted to the otolaryngologists, approximately accounting for 39% of all facial bone fractures. The most frequent mechanisms of injury consist of assault, sport-related injuries, falls, and motor vehicle accidents. In this study, we examined the effects of the COVID-19 pandemic on pediatric nasal fractures.
METHODS
Children with nasal fracture who applied to Malatya Training and Research Hospital during the year before the first case and the following year were included in this study. Data of 172 patients for the pre-pandemic period and 79 patients for pandemic were available and included in the study. Demographic information, clinical features, nasal fracture etiology, nasal fracture type, type and time of intervention, and other accompanying pathologies were recorded.
RESULTS
While falls was the leading cause of fracture etiology before the pandemic (64 patients [37.21%]), assault seems to be the leading cause during the pandemic period (27 children [34.18%]). In the pre-pandemic period, the intervention for patients with nasal fractures was performed on an average of 5 days, while this period was calculated as an average of 6 days during the pandemic period. When the 2 groups are compared in terms of nasal fracture intervention time, it was seen that the intervention time was statistically significantly later in the pandemic period ( < .001). According to the results of the analysis, the most cases in the pandemic period were seen in the fourth month, which indicated a-month period between 11 June and 11 July.
CONCLUSIONS
In conclusion, our number of nasal fracture cases was decreased during the pandemic period compared to the 1-year period before the pandemic. We observed the most common type IIA nasal fracture. We gave outpatient treatment to most of the patients. Our most common cause of fracture was assault. We intervened in our cases in an average of 6 days and preferred closed reduction most frequently. We could not find any study on the same subject in the literature, and we aimed to contribute to the literature with this study.
Topics: COVID-19; Child; Facial Bones; Humans; Nasal Bone; Nose Diseases; Pandemics; Respiratory System Abnormalities; Retrospective Studies; Skull Fractures
PubMed: 34814775
DOI: 10.1177/01455613211051309 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Sep 2020We aim to present our series on pediatric head traumas and discuss our results with the current literature.
BACKGROUND
We aim to present our series on pediatric head traumas and discuss our results with the current literature.
METHODS
The data of children who underwent treatment for head trauma in our department between 2010 and 2019 were retrospectively reviewed. Their clinical condition at admission, radiological findings, treatment methods and outcomes were analyzed.
RESULTS
Ninety children underwent treatment for head trauma, 60 of them were male and 30 were female. The mean age was 6.6 years. Linear skull fracture was seen 55 patients, while epidural hematoma in 15 patients. Twenty patients underwent surgical treatment, while 70 patients underwent conservative treatment. No patient died in our series, three patients underwent rehabilitation due to neurological deficits after discharge.
CONCLUSION
Children were more prone to head trauma, but their mortality was less than the adults. Conservative treatment should be the first goal, but surgical management should be reserved for children with significant hematoma and declining neurological conditions.
Topics: Child; Conservative Treatment; Craniocerebral Trauma; Female; Head; Hematoma, Epidural, Cranial; Humans; Male; Retrospective Studies; Skull Fractures
PubMed: 32946084
DOI: 10.14744/tjtes.2020.24287