Search

BACKGROUND: Studies on hypopituitarism (HP) following mild traumatic brain injury (mTBI) have focused on male populations although women may be more susceptible to the sequelae of mTBI. This is, to the best of our knowledge, the first all-female study screening for HP following mTBI. OBJECTIVE: Screening for possible HP in female athletes reporting a history of one or more mTBI. METHODS: Pituitary hormone screening blood tests (SBT) were performed in 133 of the 151 female athletes included. Repeated results outside the reference value (O-RV) were considered abnormal necessitating further endocrinological evaluation. RESULTS: Repeated SBT were O-RV in 88 women (66.2%). Decreased levels of serum insulin growth factor 1 (S-IGF1) were found in 55.6% of participants and elevated levels of serum prolactin (S-prolactin) in 22.6%. Serum cortisol levels were below the RV in 6.0% and thyroid hormonal levels in 11.3%. Lower age and increased number of mTBI symptoms correlated significantly with the risk of hormonal results O-RV. CONCLUSION: The majority of the study population had SBT O-RV, warranting further workup of possible HP. Decreased levels of S-IGF1 were most commonly observed followed by elevated S-prolactin possibly indicating hypothalamic-pituitary impairment. Lower age and increased number of symptoms of mTBI may indicate the need to screen for HP. [ABSTRACT FROM AUTHOR]

Objective: Patients using anticoagulant and/or antiplatelet (AC/AP) medications are at an increased risk of intracranial hemorrhage (ICH) subsequent to head trauma and current guidelines recommend a head computed tomography (CT) scan for these patients. There is a lack of consensus about management recommendations for mild head trauma patients on AC/AP treatment who had an initially normal head CT. The aim of this study was to determine the rate of delayed ICH after a 24-hour observation in patients with mild head trauma using AC/AP who had an initially normal head CT. Method: Patients aged 18 and older, using AC/AP drugs with mild head trauma were included prospectively. Patients underwent head CT for suspected bleeding. A repeat CT scan was performed after a 24-hours observation period for the patients who had an initially normal head CT for detecting delayed intracranial hemorrhage. Results: A total of 101 patients were included and, 57.4% (n=58) of the patients were female. Delayed ICH was detected in 2.9% (n=3) of the patients after a 24-hour observation. None of the patients with delayed ICH needed surgical treatment or further intervention. Delayed ICH was found in patients who used acetylsalicylic acid (n=1), dabigatran (n=1), and apixaban (n=1). Conclusion: In patients with mild head trauma using AC/AP, delayed intracranial hemorrhage is rare and may be clinically insignificant. A repeat CT scanning after 24-hour observation may not be necessary for patients with mild head trauma using AC/AP therapy who had initially normal head CT. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Hepatic encephalopathy (HE) is acommon decompensating event in patientswith cirrhosis. Because of the aging population of patients with cirrhosis, differentiating HE from nonhepatic etiologies of cognitive impairment, such as dementia, is increasingly important. METHODS: Veterans with cirrhosis were identified via International Classification of Diseases-10 codes between October 1, 2019, and September 30, 2021, using the VA Corporate Data Warehouse. Baseline characteristics were compared between cohorts based on the presence vs absence of dementia. Factors associated with having a diagnosis of dementia were evaluated using multivariate logistic regression models, adjusting for demographics, comorbid illnesses, cirrhosis etiology, and cirrhosis complications. RESULTS: A total of 71,552 veterans with cirrhosis were identified, of which, 5,647 (7.89%) veterans had a diagnosis of dementia. Veterans with dementia were older, more frequently White, urban located, and diagnosed with alcohol-related cirrhosis, metabolic syndrome, brain trauma, and cerebrovascular disease more frequently. On multivariable analysis, the presence of any decompensating event was associated with dementia. Multivariable analysis of individual decompensating events revealed HE to be associated with a dementia diagnosis, but not ascites, independent of other risk factors analyzed. DISCUSSION: Dementia is commonly diagnosed in patients with cirrhosis and correlates with a diagnosis of HE, independent of alcohol use, brain injury, age, and other metabolic risk factors. Dementia did not correlate with other decompensating events. Increased awareness of the overlap between dementia and HE, as well as reliable diagnostic and treatment strategies, is needed for the aging population of veteranswith cirrhosis. [ABSTRACT FROM AUTHOR]

Purpose: In pediatric, head trauma acute hydrocephalus is an uncommon but possible complication. Association with a subarachnoid hemorrhage is poorly described. Methods: We described a case of an 8-year-old girl with acute hydrocephalus secondary to peri-mesencephalic subarachnoid hemorrhage after mild head trauma resolved with external ventricular drainage. Furthermore, we have conducted a review of the literature about this complication in pediatric head trauma. Discussion and conclusion: Acute hydrocephalus related to post-traumatic peri-mesencephalic subarachnoid hemorrhage (tSAH) is an unknown entity in pediatric head trauma. According to our experience, traumatic peri-mesencephalic SAH should be under close clinical monitoring to identify post-traumatic hydrocephalus (PTH), a potentially fatal complication in pediatric mild head trauma. [ABSTRACT FROM AUTHOR]

Post-traumatic clival hematomas are a rare entity and almost exclusive to the pediatric population. Those of retroclival location are exceptionally rare. This entity was first described in 1941 by Coleman and Thomson, and since then, less than 30 cases have been reported in the literature. Clinically, these hematomas are usually silent and slow, but clinical state worsening may be sudden and rapidly fatal by the onset of obstructive hydrocephalus in the absence of prompt treatment. Here, the authors report a new case of pediatric post traumatic retroclival epidural hematoma following a minor blunt head trauma in a 03-year-old male patient with good outcomes. The authors will proceed with a review of the literature regarding the pathophysiology and mechanisms of occurrence of such post-traumatic injury. [ABSTRACT FROM AUTHOR]

Head trauma is the leading cause of serious injury in the older adult population with skull fractures as a serious reported outcome. This study aims to evaluate the role of sex in the risk of skull fracture in patients over the age of 65. A prospective cohort study was conducted at two level-one trauma centers, serving a population of 360,000 geriatric residents. Over a year-long period, consecutive patients aged 65 years and older who presented with blunt head injury were included. Patients who did not receive head CT imaging were excluded. The primary outcome was rate of skull fracture due to the acute trauma, compared by sex. Additional factors examined included patient race/ethnicity and mechanism of injury. Among 5402 patients enrolled, 3010 (56%) were female and 2392 (44%) were male. 4612 (85%) of the head injuries sustained were due to falls, and 4536 (90%) of all subjects were Caucasian. Overall, 199 patients (3.7%) sustained skull fractures. Males had a significantly greater rate of skull fracture when compared to females (4.6% vs 3.0%, OR 1.5, 95% CI: 1.2–2.1, p = 0.002). This trend was also seen across race/ethnicity and mechanism of injury. Older males were found to have a higher rate of skull fractures compared to females after sustaining blunt head trauma, mostly due to falls. [ABSTRACT FROM AUTHOR]

The white cerebellum sign is a radiologic sign rarely described resulting from diffuse cerebral edema, reported especially in children with hypoxic brain lesions, it is usually associated with poor prognosis leading to irreversible brain damage. We report the case of a child who presented this sign after a severe head injury and differently from most of previous cases, our patient has recovered very successfully. The white cerebellum sign is a radiologic sign that is not frequently described, which when present carries a poor prognosis, one third of the patients die and the others have severe deficits, its identification is necessary for a better patient management.

Abstract Objective To investigate whether persistent post-traumatic headache attributed to mild traumatic brain injury (TBI) is associated with more pronounced pericranial tenderness and lower pressure pain thresholds (PPTs) in the head and neck region, compared with healthy controls. Methods Patients with persistent post-traumatic headache (n = 100) and age- and gender-matched healthy controls (n = 100) were included between July 2018 and June 2019. Total tenderness score (TTS) was used to assess pericranial tenderness by bilateral manual palpation in eight muscles or tendon insertions. Summation was then used to calculate a TTS from 0 to 48 based on individual right- and left-sided scores; higher TTS score indicated more pronounced pericranial tenderness. PPTs were examined in m. temporalis and m. trapezius (upper and middle part) using an electronic pressure algometer that applies increasing blunt pressure at a constant rate. Results The TTS score was higher in patients with persistent post-traumatic headache (median, 21; IQR, 12–31), compared with healthy controls (median, 10; IQR, 6–17; P

Penetrating traumatic brain injury (pTBI) affects civilian and military populations resulting in significant morbidity, mortality, and healthcare costs. No up-to-date and evidence-based guidelines exist to assist modern medical and surgical management of these complex injuries. A preliminary literature search revealed a need for updated guidelines, supported by the Brain Trauma Foundation. Methodologists experienced in TBI guidelines were recruited to support project development alongside two cochairs and a diverse steering committee. An expert multi-disciplinary workgroup was established and vetted to inform key clinical questions, to perform an evidence review and the development of recommendations relevant to pTBI. The methodological approach for the project was finalized. The development of up-to-date evidence- and consensus-based clinical care guidelines and algorithms for pTBI will provide critical guidance to care providers in the pre-hospital and emergent, medical, and surgical settings.

Individuals who experience intimate partner violence (IPV) often report posttraumatic stress disorder (PTSD) and depressive symptoms and IPV-related head trauma (IPV-HT), which can also affect mental health. We aimed to estimate rates of IPV-HT and examine the unique associations of IPV, HT, and IPV-HT with PTSD and depression symptom severity in a community-based sample of cohabitating couples. A total of 413 participants (216 women, 1 non-binary) self-reported lifetime history of HT and physical IPV. Chi-square analyses and Fisher’s exact tests were used to compare the proportion of women and men who reported IPV-HT. Kruskal–Wallis tests with Dunn’s post-hoc testing and Bonferroni correction were used to compare symptom severity across five groups: (a) IPV-HT, (b) non-IPV-related HT (Other HT) with exposure to physical IPV (IPV-Other HT), (c) Other HT without exposure to physical IPV (No IPV-Other HT), (d) no exposure to HT with exposure to physical IPV (IPV-No HT), and (e) no exposure to HT without exposure to physical IPV (No IPV-No HT). A greater proportion of women than men reported IPV-HT from a fight or being strangled (fight: 50.0% vs. 3.6%, p < .001; Strangulation: 74.1% vs. 3.8%, p < .001). The IPV-HT and IPV-Other HT groups endorsed greater PTSD and depression symptom severity compared to all individuals with no history of physical IPV, regardless of HT exposure (IPV-No HT and IPV-Other HT groups). No differences in symptom severity between the IPV-HT and the other IPV groups (No HT and Other HT) were found. These results suggest that PTSD and depression symptom severity may be driven by experiencing physical IPV, with some exacerbation due to experiencing HT of any etiology. Future work seeking to examine the effects of IPV-HT on PTSD and depression symptom severity should consider any history of physical IPV and any additional HT exposures. [ABSTRACT FROM AUTHOR]

The analysis of circumstantial elements in post-mortem examinations is crucial for identifying perpetrators in unarmed close-range homicides. This study explores the forensic analysis of head trauma fatalities related to combat sports, blunt force trauma homicides, and traditional martial arts (TMA), aiming to bridge the gap between historical martial arts documentation and modern forensic pathology. Following PRISMA guidelines, we conducted a systematic literature review and interdisciplinary analysis combining traditional forensic methods with the study of TMA manuscripts and consultations with martial arts experts. The research uncovered a high incidence of head injuries in combat sports and identified distinct injury patterns in blunt-force trauma homicides. In martial arts, lethal techniques targeting the cranial region were pinpointed. An algorithm was developed to differentiate between injuries from various sources effectively. This study offers a framework to distinguish injuries from combat sports, homicides, and martial arts, improving diagnostic accuracy in forensic pathology. It advocates for a detailed protocol that considers the technical aspects of TMA and their forensic implications, enhancing the evaluation of head trauma cases in forensic investigations. • The characteristics of violence inflicted on a victim lead to distinct post-mortem findings. • The offender's background correlates with autopsy findings, reflecting distinct injury patterns. • Classical Japanese martial arts induce unique patterns, indicating a trained perpetrator. • Understanding the biomechanics of an injury is integral to revealing the cause of a trauma. [ABSTRACT FROM AUTHOR]

Purpose: The most prominent risk factors for mortality after mild traumatic brain injury (TBI) have not been established. This study aimed to establish risk factors related to 90-day mortality after a traumatic event. Methods: A retrospective cohort study on adult patients entering the Emergency Department of the University Hospital of Trieste for mild TBI from 1 January 2020 to 31 December 2020 was conducted. Results: The final population was 1221 patients (median age of 78 years). The 90-day mortality rate was 7% (90 patients). In the Cox regression model (likelihood ratio 110.9; p < 2 × 10−16), the variables that significantly correlated to 90-day mortality were age (less than 75 years old is a protective factor, HR 0.29 [95%CI 0.16–0.54]; p < 0.001); chronic liver disease (HR 4.59 [95%CI 2.56–8.24], p < 0.001); cognitive impairment (HR 2.76 [95%CI 1.78–4.27], p < 0.001); intracerebral haemorrhage (HR 15.38 [95%CI 6.13–38.63], p < 0.001); and hospitalization (HR 2.56 [95%CI 1.67–3.92], p < 0.001). Cardiovascular disease (47% vs. 11%; p < 0.001) and cognitive impairment (36% vs. 10%; p < 0.001) were more prevalent in patients over 75 years of age than the rest of the population. Conclusions: In our cohort of patients with mild TBI, 90-day mortality was low but not negligible. The risk factors associated with 90-day mortality included age, history of chronic liver disease, and cognitive impairment, as well as evidence of intracerebral hemorrhage and hospitalization. The mortality of the sub-population of older patients was likely to be linked to cardiovascular comorbidities and neurodegenerative diseases.

Traumatic brain injury (TBI) is a common cause of disability and mortality worldwide. TBI is an acquired brain injury that may be open (penetrating) or closed (non-penetrating) and is be categorized as mild, moderate, or severe, depending on the clinical presentation. Accurate diagnosis at the earliest stages can significantly affect patient discomfort, prognosis, therapeutic intervention, survival rates and recurrence. Whereas traditional CT and MRI techniques for diagnosis are dominant in clinical situations, a promising direction for clinical diagnosis is the use of fluid biomarkers like blood, CSF, urine, and saliva. Fluid biomarkers that may track these injuries and inflammatory processes have been explored for their potential to provide objective measures in TBI assessment. At present, there are limited clinical guidelines available regarding the use of fluid biomarkers in TBI. In recent years, saliva has received significant attention as a biomarker for TBI in clinical practice due to the non-invasive accessibility, cost-effective collection, and consistent relationship with serum. This review examines the utility of saliva biomarkers such as S100B, noncoding RNAs (ncRNAs), extracellular vesicles (EVs), miRNAs levels, microtubule-associated protein tau, alpha-amylase, cortisol, and oxidative stress in TBI. The study highlights the current state of salivary diagnostics, future aspirations, and their potential as the preferred route of TBI detection. The newly developed techniques for salivary analysis of these molecules may help to improve outcomes for TBI through rapid detection current unavailable with serum samples. Future studies via salivary biomarkers will help establish consistent strategies for early diagnosis of TBI and improve treatment outcomes of TBI patients.

BackgroundSubgaleal hematoma is a well-known life-threatening complication of instrumentation at birth. Even though most cases of subgaleal hematomas occur in the neonatal period, older children and adults are also at risk for subgaleal hematomas and their complications, following head trauma.ObjectiveWe hereby report the case of a 14-year-old boy who presented with a traumatic subgaleal hematoma requiring drainage and review the relevant literature regarding potential complications and indications for surgical intervention.ResultsInfection, airway compression, orbital compartment syndrome and anemia requiring transfusion are potential complications of subgaleal hematomas. Although rare, surgical drainage and embolization are occasionally required interventions.ConclusionSubgaleal hematomas following head trauma can occur in children beyond the neonatal period. Large hematomas may require drainage to relieve pain or when compressive or infectious complications are suspected. Although usually not life-threatening, physicians taking care of children must be cognizant of this entity when caring for a patient with a large hematoma following head trauma and in severe cases, consider a multidisciplinary approach.

Of all our organs, the brain is perhaps the best protected from trauma. The skull has evolved to enclose it and, within the skull, the brain floats in a protective bath of cerebrospinal fluid. It is becoming evident, however, that head trauma experienced in young adult life can cause a dementia that appears decades later. The level of trauma that induces such destruction is still being assessed but includes levels well below that which cracks the skull or causes unconsciousness or concussion. Clinically this damage appears as dementia, in people who played body-contact sports in their youth or have survived accidents or the blasts of combat; and appears also, we argue, in old age, without a history of head trauma. The dementias have been given different names, including dementia pugilistica (affecting boxers), chronic traumatic encephalopathy (following certain sports, particularly football), traumatic brain injury (following accidents, combat) and Alzheimer’s (following decades of life). They share common features of clinical presentation and neuropathology, and this conceptual analysis seeks to identify features common to these forms of brain injury and to identify where in the brain the damage common to them occurs; and how it occurs, despite the protection provided by the skull and cerebrospinal fluid. The analysis suggests that the brain’s weak point in the face of trauma is its capillary bed, which is torn by the shock of trauma. This identification in turn allows discussion of ways of delaying, avoiding and even treating these trauma-induced degenerations.

Chronic traumatic encephalopathy (CTE) is associated with pathological changes, yet detecting these changes during life has proven elusive. Positron emission tomography (PET) offers the potential for identifying such pathology. Few studies have been completed to date and their approaches and results have been diverse. It was the objective of this review to systematically examine relevant research using ligands for PET that bind to identified pathology in CTE. We focused on identification of patterns of binding and addressing gaps in knowledge of PET imaging for CTE. A comprehensive literature search was conducted. Data used were published on or before May 22, 2017. As the extant literature is limited, any peer-reviewed article assessing military, contact sports athletes, or professional fighters was considered for inclusion. The main outcomes were regional binding to brain regions identified through control comparisons or through clinical metrics (e.g., standardized uptake volume ratios). A total of 1207 papers were identified for review, of which six met inclusion criteria. Meta-analyses were planned but were deemed inappropriate given the small number of studies identified. Methodological concerns in these initial papers included small sample sizes, lack of a control comparison, use of nonstandard statistical procedures to quantify data, and interpretation of potentially off-target binding areas. Across studies, the hippocampi, amygdalae, and midbrain had reasonably consistent increased uptake. Evidence for increased uptake in cortical regions was less consistent. The evidence suggests that the field of PET imaging in those at risk for CTE remains nascent. As the field evolves to include more stringent studies, ligands for PET may prove an important tool in identifying CTE in vivo.

ObjectiveThe aim was to analyze the impact of decreased head computed tomography (CT) imaging on detection of abnormalities and outcomes for children with isolated head trauma.MethodsThe study involves a multicenter retrospective cohort of patients younger than 19 years presenting for isolated head trauma to emergency departments in the Pediatric Health Information System database from 2003 to 2015. Patients directly admitted or transferred to another facility and those with a discharge diagnosis code for child maltreatment were excluded. Outcomes were ascertained from administrative and billing data. Trends were tested using mixed effects logistic regression, accounting for clustering within hospitals and adjusted for age, sex, insurance type, race, presence of a complex chronic condition, and hospital-level case mix index.ResultsBetween 2003 and 2015, 306,041 children presented for isolated head trauma. The proportion of children receiving head CT imaging was increasing until 2008, peaking at just under 40%, before declining to 25% by 2015. During the recent period of decreased head CT imaging, the detection of skull fractures (odds ratio [OR]/year, 0.96; 95% confidence interval [CI], 0.95-0.97) and intracranial bleeds (OR/year, 0.96; 95% CI, 0.94-0.97), hospitalization (OR/year, 0.96; 95% CI, 0.95-0.96), neurosurgery (OR/year, 0.91; 95% CI, 0.87-0.95), and revisit (OR/year, 0.98; 95% CI, 0.96-1.00) also decreased, without significant changes in mortality (OR/year, 0.93; 95% CI, 0.84-1.04) or persistent neurologic impairment (OR/year, 1.03; 95% CI, 0.92-1.15).ConclusionsThe recent decline in CT scanning in children with isolated head trauma was associated with a reduction in detection of intracranial abnormalities, and a concomitant decrease in interventions, without measurable patient harm.

Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening condition, particularly in children. We present a case of a 6-year-old boy who presented to the emergency department with headache and vomiting following a minor head injury. Initial computed tomography scan showed a small retrocerebellar subdural hematoma and further investigation revealed thrombosis of the right sigmoid sinus. Despite the presence of associated hematomas, the patient was initiated on anticoagulation therapy and demonstrated clinical and radiological improvement. CVST following head trauma is rare in children but should be considered in cases where symptoms persist despite normal initial imaging. Early diagnosis and anticoagulation therapy can lead to successful outcomes. [ABSTRACT FROM AUTHOR]

Objective: To examine whether white matter hyperintensities (WMHs) and cerebral microbleeds (CMBs) are more prevalent in people with persistent post-traumatic headache attributed to mild traumatic brain injury (TBI), compared with healthy controls. Methods: A magnetic resonance imaging (MRI) study of adults with persistent post-traumatic headache attributed to mild TBI and age- and gender-matched healthy controls. A semi-structured interview and validated self-report instruments were used to record data on demographics, clinical characteristics, and comorbidities. Imaging data were obtained on a 3T MRI Scanner using a 32-channel head coil. Participants and controls underwent a single MRI session, in which fluid-attenuated inversion recovery was used to visualize WMHs, and susceptibility-weighted imaging was used to detect CMBs. The primary outcomes were (I) the difference in the mean number of WMHs between participants with persistent post-traumatic headache and healthy controls and (II) the difference in the mean number of CMBs between participants with persistent post-traumatic headache and healthy controls. All images were examined by a certified neuroradiologist who was blinded to the group status of the participants and controls. Results: A total of 97 participants with persistent post-traumatic headache and 96 age- and gender-matched healthy controls provided imaging data eligible for analyses. Among 97 participants with persistent post-traumatic headache, 43 (44.3%) participants presented with ≥ 1 WMH, and 3 (3.1%) participants presented with ≥ 1 CMB. Compared with controls, no differences were found in the mean number of WMHs (2.7 vs. 2.1, P = 0.58) and the mean number of CMBs (0.03 vs. 0.04, P = 0.98). Conclusions: WMHs and CMBs were not more prevalent in people with persistent post-traumatic headache than observed in healthy controls. Future studies should focus on other MRI techniques to identify radiologic biomarkers of post-traumatic headache. [ABSTRACT FROM AUTHOR]

Cephalhematoma is a frequent condition in newborn infants due to birth‐related trauma, but ossified cephalhematoma (OCH) is a rare condition, especially when it presents as a skull lesion in the older pediatric population. Chronic intradiploic hematoma (CIH) is another rare condition caused by an organized hematoma between the inner and outer tables of the skull. Differentiating CIH from OCH could be difficult for young neurosurgeons. We present an 18‐month‐old girl with an OCH presented as a skull lesion, which was managed with craniectomy and en‐bloc excision of the organized hematoma. This manuscript discusses the differences between OCH and CIH in diagnosis and management. [ABSTRACT FROM AUTHOR]

Equestrians have a high risk of concussions per hospital records. However, most concussions occur in private settings where concussions are not tracked. We determined concussion incidence by self-report, expressed per 1000 h of exposure, and determined helmet usage and concussion knowledge. Descriptive epidemiological study. Equestrians were recruited using a snowball method of sampling in which enrolled participants recruited more equestrians. Participants completed a survey of equestrian experience and history of concussion, symptoms and provided estimates of hours spent in various equestrian activities. From these data, incidences of concussions were calculated. In addition, they answered questions regarding helmet usage and willingness to take risks when concussed. 210 participants (203 women) reported 27 ± 14 years of equine experience and 728 concussions, 3.47 ± 5.34 per person (0–55). Incidence while riding was 0.19/1000 h which was greater than the incidence while driving (0.02/1000 h) or handling horses (0.03/1000 h). Riders were helmeted at the time of injury 85% of the time. While concussion knowledge was high, most reported willingness to risk permanent injury by continuing to work with horses while injured. To our knowledge this is the first study to document incidence of concussions in equestrians: incidence is higher while riding than during football or rugby training. Helmets were far more commonly worn at the time of concussion than reported in hospital data, suggesting that helmets effectively reduce concussions severe enough to warrant urgent medical care. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This review article highlights the disparities evident in pediatric trauma care in the United States. Social determinants of health play a significant role in key aspects of trauma care including access to care, gun violence, child abuse, head trauma, burn injuries, and orthopedic trauma. We review the recent literature as it relates to these topics. The findings from these recent studies emphasize the important principle that trauma care for children should be designed with a focus on equity for all children. [ABSTRACT FROM AUTHOR]

A high prevalence of depression exists in specific sub-samples of survivors of brain injury (BI) sustained from intimate partner violence (IPV). However, the experience of depression by survivors of IPV-related BI from general civilian populations remains unclear. This study documents the symptom profile of depression reported by individuals who screened positive for sustaining an IPV-related BI. 36 individuals who screened positive for possible IPV-related BI completed the Beck Depression Inventory-2nd Edition (BDI-II). Subscales characterizing the nature of the symptoms were created. Frequency and descriptive statistics were calculated for item responses on the BDI-II. Participants were also assigned to high or low symptom severity groups to examine between-group differences. Participants endorsed experiencing somatic symptoms more severely than self-evaluative and affective symptoms. Additionally, self-evaluative and cognitive symptoms correlated with total BDI-II scores for the high symptom severity group but not for the low symptom severity group. The findings highlight somatic symptoms of depression, in particular as a common experience among survivors of IPV-related BI. Further, self-evaluative and cognitive symptoms may be more sensitive in detecting depression after IPV-related BI. These results may aid in the development of guidelines to better diagnose and treat depression in IPV-related BI. [ABSTRACT FROM AUTHOR]

Background: Civil war in Syria that started in 2011 has caused death and injuries of thousands of people. Head trauma is one of the most important surgical emergencies both in wartimes and out of wartimes. Materials and methods: A total of 75 patients (58 males and 17 females) who presented with head trauma due to gunshot injuries such as bullet and shrapnel during the Syrian war between 2014 and 2015 were evaluated retrospectively. Patients who had neurological and radiological examinations were included in the study. Results: Twenty (26.67%) of 75 patients admitted to our hospital due to head trauma with penetrating gunshot died. The mortality rate of patients with brain parenchymal hemorrhage was found to be significantly higher than those without (p<0.001). The mortality rate of patients with brain edema was found to be significantly higher than those without (p=0.003). In addition, the mortality rate in patients with ventricular hemorrhage and subarachnoid hemorrhage were found to be significantly higher than those without (p=0.081 for ventricular hemorrhage, p=0.056 for subarachnoid hemorrhage). Conclusion: Radiological imaging makes an important contribution to creating the necessary data in the first intervention in patients with head trauma injured by gunshot, in the decision of surgical emergency intervention if necessary, and in the management of complications. [ABSTRACT FROM AUTHOR]

Tension pneumocephalus is a rare and life-threatening neurosurgical emergency in the setting of blunt or penetrating head trauma, especially in those with craniofacial fractures, which emergency physicians should be aware about. Early identification and appropriate treatment measures including supine positioning, 100% oxygen via mask, early neurosurgery consultation and, if required, operative intervention are paramount to optimal neurological and survival outcome. Definitive diagnosis requires imaging usually in the form of computed tomography (CT) head and serial monitoring of neurological status, optic nerve sheath diameter measurement and repeat imaging, essential to identify patients who might have features of increased pressure on brain matter, which could lead to adverse neurological and clinical outcomes. We present two cases of tension pneumocephalus with the characteristic Mount Fuji sign on CT head, who were managed nonoperatively with optimal neurological outcome. In patients with severe head or maxillofacial trauma presenting to emergency department, CT should be evaluated for signs of tension pneumocephalus, and such patients need to be closely observed for complications of pressure effect on brain matter to ensure optimal neurological and survival outcomes. [ABSTRACT FROM AUTHOR]

Background: Currently, there are few studies considering possible modifiable risk factors of frontotemporal dementia (FTD).Objective: In this retrospective case-control study, we evaluated whether a history of traumatic brain injury (TBI) associates with a diagnosis of FTD or modulates the clinical phenotype or onset age in FTD patients.Methods: We compared the prevalence of prior TBI between individuals with FTD (N = 218) and age and sex-matched AD patients (N = 214) or healthy controls (HC; N = 100). Based on the patient records, an individual was categorized to the TBI+ group if they were reported to have suffered from TBI during lifetime. The possible associations of TBI with age of onset and disease duration were also evaluated in the whole FTD patient group or separately in the sporadic and genetic FTD groups.Results: The prevalence of previous TBI was the highest in the FTD group (19.3%) when compared to the AD group (13.1%, p = 0.050) or HC group (12%, p = 0.108, not significant). Preceding TBI was more often associated with the sporadic FTD cases than the C9orf72 repeat expansion-carrying FTD cases (p = 0.003). Furthermore, comparison of the TBI+ and TBI- FTD groups indicated that previous TBI was associated with an earlier onset age in the FTD patients (B = 3.066, p = 0.010).Conclusion: A preceding TBI associates especially with sporadic FTD and with earlier onset of symptoms. The results of this study suggest that TBI may be a triggering factor for the neurodegenerative processes in FTD. However, understanding the precise underlying mechanisms still needs further studies. [ABSTRACT FROM AUTHOR]

Simple Summary: Sea turtles are considered an endangered species, largely due to anthropogenic activities. Severe trauma in these species mainly involves the carapace and head. Studies on the incidence of head trauma in sea turtles and analysis of the survival rate after hospitalization performed on many subjects examined over a long period of time were missing in the scientific literature. In this retrospective study, we evaluated 1877 Caretta caretta, 29 of which showed head trauma. The severity of head injuries was assessed clinically and by neurological examination. CT examination was essential to evaluate the impaired central nervous system and sense organs. According to our scoring classification, most head traumatized turtles had severe injuries but in most cases, the animals showed no alteration in mentation state. Only 28% (8/29) of the turtles showed head damage related to severe neurological deficits. Indeed, 21 out of 29 sea turtles were released after a time ranging from a few days to 8 months. To the best of our knowledge, the literature lacks specific data on the incidence, correlations with neurological deficits, complications, and survival rate of traumatic head injuries in loggerhead sea turtles. Sea turtles are considered endangered species, largely due to anthropogenic activities. Much of the trauma in these species involves the carapace and skull, resulting in several degrees of damage to the pulmonary and nervous systems. Among traumatic injuries, those involving the skull can be complicated by brain exposure, and turtles with severe skull injuries that have nervous system impairment, emaciation, and dehydration can often die. Between July 2014 and February 2022, a total of 1877 loggerhead sea turtles (Caretta caretta) were referred for clinical evaluation at the Sea Turtle Clinic (STC) of the Department of Veterinary Medicine of the University of Bari. A retrospective study of 29 consecutive cases of loggerhead sea turtles (Caretta caretta) with skull lesions of different degrees of severity is reported. On admission, physical and neurological evaluations were performed to assess and grade the lesions and neurological deficits. In 20 of the 29 sea turtles with more serious head trauma, computed tomography (CT) findings in combination with physical and neurological assessment enabled the evaluation of the potential correlation between deficits and the extent of head injuries. All sea turtles underwent curettage of the skull wounds, and the treatment protocol included the use of the plant-derived dressing 1 Primary Wound Dressing® (Phytoceutical AG, Endospin Italia) applied on the wound surface as a primary dressing. Out of 29 sea turtles, 21 were released after a time ranging from a few days to 8 months. To the best of our knowledge, the literature lacks specific data on the incidence, correlations with neurological deficits, complications, and survival rate of loggerhead sea turtles with traumatic head injuries. [ABSTRACT FROM AUTHOR]

Objectives: Few studies have assessed pregnancies and deliveries after traumatic brain injury (TBI). We report the incidence of TBIs and TBI-related surgeries in fertile-aged females and investigate subsequent pregnancy outcomes. Methods: All fertile-aged (15–49) women with TBI diagnosis during our study period (1998–2018) were retrieved from the Care Register for Health Care and combined with data from the National Medical Birth Register. TBIs were categorized into three subgroups based on the length of the hospitalization period and the need for neurosurgery. Logistic regression was used to analyze preterm deliveries, cesarean sections (CS) and neonatal health. Results are reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI). Results: The incidence of TBIs increased from 103 per 100 000 person-years in 1998 to 257 per 100 000 (149.5%) in 2018. The incidence of TBI-related surgeries remained stable during our study period. The rate of preterm deliveries was 5.6% in the TBI group and 3.0% in the control group (AOR 1.23, CI 1.17–1.28). The CS rate in the TBI group was 19.2% and 15.9% in the control group (AOR 1.23, CI 1.18–1.29). The use of labor analgesia was higher among women with previous TBI. The rate of neonates requiring intensive care in the TBI group was 13.1% and 9.9% in the control group (AOR 1.30, CI 1.24–1.37). Conclusion: The incidence of TBI hospitalizations increased during our study period, whereas the number of surgically treated TBI remained stable. Preterm deliveries, CS, instrumental vaginal deliveries and labor analgesia were more prevalent in women with previous TBI. Furthermore, more neonates required intensive care in this group. Therefore, a history of TBI should be acknowledged as a possible factor affecting the delivery and health of the neonate. [ABSTRACT FROM AUTHOR]

Background: Head trauma are a widespread problem. The concept of a head injury includes fracture of the cranial and facial bones, and injury to specific sensory and brain regions. The outcome in terms of surviving in such traumatic brain injury circumstances depends on the kind of weapons utilized, the kind and position of the skull fracture, and cerebral haemorrhage. Material and Methods: 176 head injuries were studied prospectively. The investigation was conducted at Department of Forensic Medicine and Toxicology, Kakatiya Medical College, Warangal, Telangana, India where 13 to 75-year-olds were affected. The study beginning with June 2021 to May 2022. Cases divided into non-fatal head injuries (Group A) and Fatal head injuries (Group B). Every case was assessed for age, sex, residency, trauma, effect, treatment, fate, and complications. The Chi Square test was used to compare categorical variables, while the ANOVA test was used to examine the age variable across the two research groups. Both tests required a P value of 0.05 or less. SPSS Software version 16 was used. Results: Group A had 44.4% men, Group B 55.6% and 56.3% women in Group A and B with 43.7%. Group A blunt trauma was 65.8% while group B was 34.2%. Rural areas have more blunt trauma cases. 80 blunt trauma patients in Group A and 91 cases in Group B had lacerated wounds. Temporal bone fractures occurred in 42 non-fatal Group A and 10 fatal group B patients. Group A had 43 depressed fractures (95.6%), while group B had 2 (4.4%). 39 group A (62.9%) and 23 group B (37.1%) instances have subdural haemorrhage. Complications is seen in 17 cases after conservative treatment and 27 cases after trephine. Conclusion: Light weapons are insufficient to cause fatal head injuries, there is a significant difference between the sexes in head injury fatality and outcome, getting older is linked to a poor outcome. Head injuries are more common in rural areas than in urban areas, and there is a very high mortality rate in rural areas due to a lack of facilities. The new investigation supports these and other conclusions. [ABSTRACT FROM AUTHOR]

Introduction: Head trauma is a major public health problem accounting for thousands of admissions each year and costing the healthcare system billions of dollars. The majority of patients with head trauma are seen in the emergency department; the head injury is often associated with other organ injuries as well. Of all serum electrolytes, the most common electrolyte subject to imbalance in TBI patients is serum sodium. The most common electrolyte imbalance condition in TBI was hypernatremia followed by hyponatremia and hypokalemia. Hyponatremia as being a common electrolyte disturbance in cases of TBI, which was most often caused by a disorder known as the syndrome inappropriate antidiuretic hormone (SIADH). Material and Methods: This is a prospective and observational study was conducted in the Department of Biochemistry, Shadan Institute of Medical Sciences, Teaching Hospital and Research center among 45 patients admitted to our ICU were enrolled in the study. Either gender between 18-65 years, Injury withing first 12-24 hours including mild, moderate and severe head injury and Resuscitation according to ACLS protocol included. Patients in shock with a low Glasgow Coma Scale (GCS) score or any polytrauma patient where initial aggressive resuscitation was done outside ICU were excluded from the study. Results: In our study, Males are Affected More than female. In our study, most the (14) patients were age group 20-30 years followed by 13 patients were 50-60 years, 11 patients were 30-40 years and 7 patients were 40-50 years. In our study, Majority Patients are Grades of Injury are Mild. Out of 45 patients, 12 patients had disturbance of K+ Which is quite less common that hyponatremia but it was more noticeable. In our study, out 45 patients, 6 patients had hyponatremia. Na+ 130 for contusion and SAH with GCS of 8/15 (Severe TBI). Na+ 131 for diffusion axonal injury with GCS of 6/15 (Severe TBI). Na+ 128 for diffusion axonal injury with GCS of 3/15, 8/15 (Severe TBI) in 2 patients. Na+ 135 in 2 cases with contusions and EDH, SDH. Conclusion: Our study demonstrated that patients with TBI have a very strong propensity to develop electrolyte imbalance, particularly hyponatraemia and hypokalaemia. Hyponatremia may be the result of SIADH or cerebral salt wasting syndrome that is common in TBI. Hyponatremia in SAH results from the release of ANP (atrial natriuretic peptide) that can cause fluid and sodium loss in urine. Hypokalaemia may also be the result of urinary loss of potassium. [ABSTRACT FROM AUTHOR]

Copyright of Bulletin of Legal Medicine / Adli Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Imaging justification considers the risk–benefit ratio to avoid unnecessary radiation exposure. The use of high-radiation)dose imaging modalities, including computed tomography, has increased. In Saudi Arabia, no clear guidelines exist for protecting pediatric patients from unnecessary exposure to ionizing radiation. We aimed to investigate the frequency of unjustified head computed tomography scans among pediatric patients at our hospital. In this study, we enrolled pediatric patients (0–14 years old) who underwent head computed tomography scans between September 2015 and September 2017, and evaluated the frequency of unjustified scans. Among the 1,109 scans, 40.6% (n = 450) had no findings; of these, 68.4% (n = 308) were justified and 31.6% (n = 142) were not. The majority of “no finding” cases were from the emergency department; (285 [63.3%]) and were from patients >5 years old (203 [45.1%]). Thirty percent of “no findings” cases from the emergency department were not justified and 19% were incompatible with the modality. Approximately 40% of cases from the outpatient departments were neither justified nor compatible with this modality. Our findings highlight the need for regular auditing to justify scan requests and a clinical decision system for medical imaging using ionizing radiation. [ABSTRACT FROM AUTHOR]

Penetrating vascular injury has become the topic of interest with increased gun violence in the United States. The radiologist plays a crucial role in establishing and systemizing the signs of vascular injury such as intimal flap, dissection, pseudoaneurysm, rupture, and arteriovenous fistula. Various imaging techniques such as ultrasound Doppler, computed tomographic angiography (CTA), magnetic resonance angiography, and conventional angiography are being employed based on clinical recommendations. Of all the techniques, CTA has been shown to embrace a promising role in identifying vascular injuries with superior sensitivity, specificity, and accuracy. An acquaintance of the imaging features has been shown to improve the approach to trauma patients in clinical settings. This article details the imaging modalities and the features of the head-and-neck penetrating vascular injury. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Former professional collision sport (CS) athletes, particularly American football players, are at risk of developing chronic health conditions; however, little is known about the health outcomes of amateur athletes., Methods: A 60-item health survey examined self-reported symptoms and diagnoses among former Division 1 Collegiate CS athletes and non- or limited-contact sport (non-CS) athletes. Binary logistic regressions tested the association between playing CS and health outcomes., Results: Five hundred and two (6.2%) participants completed the survey: 160 CS athletes (mean age: 59.2, SD = 16.0) and 303 non-CS athletes (mean age: 54.0, SD = 16.9). CS athletes had increased odds of reported cognitive complaints and neuropsychiatric symptoms including memory (P adj < 0.01), attention/concentration (P adj  = 0.01), problem solving/multi-tasking (P adj  = 0.05), language (P adj  = 0.02), anxiety (P adj  = 0.04), impulsivity (P adj  = 0.02), short-fuse/rage/explosivity (P adj < 0.001), and violence/aggression (P adj  = 0.02). CS athletes also reported higher rates of sleep apnea (P adj  = 0.02). There were no group differences in cardiovascular and physical health outcomes., Conclusions: Former CS athletes reported more cognitive and neuropsychiatric complaints. The low response rate is a limitation of this study; however, over 500,000 athletes play college sports each year, thus research on long-term health outcomes in this population is critical.

Subconcussive impacts are very common in the sports world and can have many negative impacts on human function, including increased risk for cognitive decline and behavioral impairments such as chronic traumatic encephalopathy (CTE). The purpose of this article is to analyze the available literature on the effects of jugular vein compression applied by a cervical collar on cerebral structure and function in the setting of chronic impact exposure. This narrative review analyzed 17 articles on brain structure and function, published between 1992 and 2022. Our review of the 17 studies shows an overall neuroprotective effect of the external jugular vein compression applied by the cervical collar during insult to the head as compared to groups who did not wear a collar. These findings suggest a potential role of the cervical collar, in addition to helmets, in reducing the incidence of concussion-induced microtraumas and cascading secondary injury mechanisms. Though positive results are consistent throughout the studies, future studies with increased sample sizes are necessary to create precise estimates of the effects of the cervical collar. In addition, the analyzed studies mainly looked at the effects of the cervical collar on football players, soccer players, and Special Weapons and Tactics (SWAT) team members; thus, additional rigorous studies are needed to assess the impact of the cervical collar on other high-risk populations such as military and law-enforcement personnel, among others., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Brieck et al.)

Objectives: To investigate the clinical characteristics and prognosis of infants and young children with basal ganglia infarction after minor head trauma (BGIMHT)., Methods: A retrospective analysis was conducted on the clinical data and follow-up results of children aged 28 days to 3 years with BGIMHT who were hospitalized at Children's Hospital of Soochow University from January 2011 to January 2022., Results: A total of 45 cases of BGIMHT were included, with the most common symptom being limb movement disorders (96%, 43/45), followed by facioplegia (56%, 25/45). Cerebral imaging showed that 72% (31/43) had infarction accompanied by basal ganglia calcification. After conservative treatment, 42 children (93%) showed significant symptom improvement, while 3 children (7%) experienced recurrent strokes. The median follow-up time was 82 months (range: 17-141 months). At the last follow-up, 97% (29/30) had residual basal ganglia softening lesions. Among 29 cases participating in questionnaire follow-up, 66% (19/29) recovered normally, 17% (5/29) showed significant improvement in symptoms, and 17% (5/29) had poor improvement. According to the grading of the Global Burden of Disease Control Projects, only 1 child (3%) had severe sequelae. There were no significant differences in age at onset, gender, or presence of concomitant basal ganglia calcification between children with and without neurological sequelae ( P >0.05)., Conclusions: The most common initial symptom of BGIMHT is limb movement disorder, and imaging results indicate that most children have concurrent intracranial calcifications. Most infarct lesions later transform into softening lesions, resulting in a generally good prognosis.

Background: : With more than 60 million new cases around the world each year, traumatic brain injury (TBI) causes substantial mortality and morbidity. Managing TBI is a major human, social, and economic concern. In the last 20 years, there has been an increase in clinical trials in neurocritical care, leading mostly to negative results. The evaluation of neurological outcomes, predominantly as primary outcomes, using clinical scales (Glasgow Outcome Scale) has limitations that could explain these results. Moreover, patient-centered outcomes are seldom reported despite their recognized clinical relevance., Objective: : The aim of this project is to establish a core outcome set (COS) for patients with moderate-to-severe TBI in randomized control trials in neurocritical care research., Methods: This study will follow five distinct steps: (1) systematic review to identify outcomes that have been reported in trials; (2) semistructured interviews with patients and their families to identify their priorities after TBI and explore potential patient-centered outcomes; (3) health care stakeholder focus groups with clinicians, researchers, and policy makers to describe potential outcomes; (4) an eDelphi survey with stakeholder groups to make a list of previously identified core outcomes; and (5) a consensus workshop to establish a COS for moderate-to-severe TBI clinical trials., Results: : The systematic review was published in August 2024. Regarding Step 2, 30 semistructured interviews of patients and relatives were performed from July 2021 to December 2023, and analyses were completed in October 2024. Step 3 is currently under development, and Step 4 is planned for the end of 2025. Step 5 is expected to occur during fall/winter 2026. Conclusions: Establishing a COS, to be consistently measured and reported in TBI trials in neurocritical care will ensure rigorous reporting, avoid bias, and improve the integrity, transparency, and usability of clinical research. The French context of the study is the main limitation, but we are seeking international collaboration on the project. The results of each step of the project will be disseminated through abstracts, publications, and patient associations., Conclusions: Establishing a COS, to be consistently measured and reported in TBI trials in neurocritical care will ensure rigorous reporting, avoid bias, and improve the integrity, transparency, and usability of clinical research. The French context of the study is the main limitation, but we are seeking international collaboration on the project. The results of each step of the project will be disseminated through abstracts, publications, and patient associations., International Registered Report Identifier (irrid): DERR1-10.2196/54525., (©Raphael Cinotti, Yvan Derouin, Amandine Chenet, Lydia Oujamaa, Bertrand Glize, Yoann Launey, Claire Dahyot-Fizelier, Emmanuelle Cartron, Melodie Renvoise, Benedicte Sautenet, Veronique Sebille. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 09.01.2025.)

Objective: Pediatric traumatic brain injury (TBI) represents a significant public health concern and source of resource utilization. The aim of this study was to establish the ability of the previously published pediatric Brain Injury Guidelines (pBIG) to identify patients with traumatic intracranial hemorrhage (ICH) who might not require routine repeat neuroimaging, neurosurgical consultation, or hospital admission in a large level I and level II trauma cohort., Methods: Pediatric patients who presented with traumatic ICH between 2018 and 2022 at the included institutions were retrospectively reviewed and sorted into pBIG categories using clinical and radiographic criteria. Nonaccidental trauma was excluded. Repeat neuroimaging and results, neurosurgical intervention, length of stay (LOS), and 30-day mortality and re-presentation to healthcare were collected as outcomes., Results: A cohort of 955 patients (median age 7.0 years, with 64.5% of patients being male) were included. Overall, 9.7% of patients had pBIG 1 injuries, 30.0% had pBIG 2 injuries, and 60.2% had pBIG 3 injuries. A total of 368 (38.5%) of patients underwent repeat neuroimaging, of whom 144 (39.1%) showed progression of hemorrhage. Neurosurgical intervention was performed in 129 (13.5%) patients, with 127 (98.4%) of them meeting pBIG 3 criteria on arrival. The two remaining patients met pBIG 2 criteria on arrival and then progressed to meet pBIG 3 criteria within 24 hours. Patient meeting pBIG 3 criteria were significantly more likely to have progression on repeat imaging, require neurosurgical intervention, and experience 30-day mortality (p < 0.001). Within the pBIG 3 cohort, there was not a significant relationship between progression on repeat imaging and the need for intervention (p = 0.61). Post hoc pairwise testing of individual radiographic pBIG groupings revealed pBIG 3 criteria for all categories except subarachnoid hemorrhage (SAH) to be predictive of need for neurosurgical intervention (p < 0.05)., Conclusions: Algorithmic management of mild TBI is beneficial to patient care. With zero and near-zero rates of neurosurgical intervention and mortality in patients with pBIG 1 and pBIG 2 injuries, respectively, the pBIG are valid in stratifying a larger and broader population of pediatric TBI patients. In contrast to other pBIG 3-defined compartment ICHs, "scattered" SAH does not correlate with need for neurosurgical intervention. However, these guidelines have the ability to safely improve care and decrease unnecessary resource utilization without negatively affecting patient outcomes. Utilization of guidelines of any sort are not intended to supersede clinical judgment. Prospective studies are needed.

Objective: Mild traumatic brain injury (mTBI) is frequently overlooked in polytrauma patients due to the overshadowing of more severe injuries, a fact that makes its identification in post-acute settings challenging since symptoms overlap with other conditions and no validated diagnostic tools exist. To address this gap, this scoping review explored the literature on mTBI diagnosis in post-acute civilian polytrauma settings., Methods: By utilizing the Arksey and O'Malley framework and PRISMA-ScR guidelines, the review focused on studies from 2010 to 2024 related to delayed mTBI diagnosis in adults. Of the 696 studies identified, only six met the inclusion criteria, highlighting the limited research in this area., Results: The review assessed various diagnostic tools including the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), neuropsychological tests, advanced imaging, and oculomotor assessments. However, these tools are limited in their ability to confirm whether an mTBI has occurred. The American Congress of Rehabilitation Medicine's updated mTBI criteria may offer the best diagnostic potential but require validation., Conclusion: According to the findings, there is a significant gap in validated diagnostic tools for mTBI in post-acute settings, which may negatively affect patient outcomes. Developing and validating effective screening tools for mTBI in the post-acute polytrauma setting should be the priority of future research in this area.

Aim: The aim of this study is to describe circumstances, management and short-term outcomes of neonatal head trauma, and adherence to the Paediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rule for children under 2 years., Methods: Multicentre retrospective cohort study of neonates (<29 days) with head trauma across 25 emergency departments (ED) from January 2017 to June 2021., Results: A total of 492 neonates (median age 17 days, range 0-28 days) with non-trivial head trauma were enrolled. Falls were the most common injury mechanism (375/492, 76.2%). Imaging was performed in 150/492 (30.5%) neonates. Clinically important traumatic brain injury (ciTBI), defined as death, neurosurgery, prolonged intubation, or extended hospitalisation from injury, occurred in 7/492 (1.4%) cases. Notably, 286/492 (58.1%) neonates were managed by short-term observation (<48 h), and 126/492 (25.6%) were admitted. Among high-risk neonates per PECARN criteria, 17/21 (80.9%) did not undergo recommended head CT scans but were observed within ED short observation units or underwent alternative imaging, with no ciTBI diagnoses among those discharged without CT., Conclusion: Severe neonatal head injuries are rare, and most neonatal head injuries have a favourable outcome, making observation a suitable approach, while remaining vigilant for signs of non-accidental injuries., (© 2024 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

A growing skull fracture (GSF) is a fracture that gradually widens as the arachnoid membrane or brain parenchyma herniates into the fractured space in a skull fracture accompanied by dural injury. GSF has a good prognosis if diagnosed early and treated surgically. However, it is generally a chronic complication with low incidence, making diagnosis difficult. Here, we present the case of a 13-month-old female infant who underwent surgical intervention for a GSF that grew rapidly within 3 weeks with a good outcome., Competing Interests: Conflict of Interest: The authors have no financial conflicts of interest., (Copyright © 2024 Korean Neurotraumatology Society.)

Traumatic cerebrospinal fluid (CSF) leakage from skull base fractures increases the risk of bacterial meningitis, which is associated with a high mortality rate in adults, and commonly results in severe neurological outcomes. While most cases of CSF leakage occur within three months post-injury and generally resolve spontaneously, delayed-onset meningitis remains a challenging complication. Herein, we report a rare case of severe bacterial meningitis with an intraventricular abscess one year following a frontal skull base fracture, despite no CSF leak. A 68-year-old man with a history of a frontal skull base fracture due to a motor vehicle accident presented with seizures, fever, and altered consciousness. Imaging revealed ventriculitis, while laboratory findings confirmed bacterial meningitis caused by Streptococcus pneumoniae . Following initial antibiotic therapy, imaging revealed a new abscess near the fracture site, indicating potential bacterial entry due to a dural injury. Surgical repair was performed using a periosteal pedicle flap to close the intracranial space from the paranasal sinus. Postoperatively, antibiotic treatment resolved the abscesses, and the patient was subsequently treated for postmeningitis hydrocephalus. This case underscores the risk of delayed-onset meningitis in patients with large skull base fractures, even those without CSF leaks. In cases of skull base trauma with bone defects, a potential occult dural injury should be considered. If meningitis develops, surgical dural repair should be evaluated in addition to antibiotic treatment, regardless of the presence of a CSF leak, to effectively manage the infection and prevent a poor prognosis., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Sakai City Medical Center Institutional Review Board issued approval 21-232. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ozaki et al.)