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Background: Traumatic brain injuries involving the posterior fossa are rare and case reports indicate they often result in severe outcomes. We seek to describe characteristics and outcomes of traumatic posterior fossa injuries. Methods: We performed a planned secondary analysis of all patients with posterior fossa injuries enrolled in the NEXUS head computed tomography (CT) validation study dataset. The dataset includes prospectively collected data on all patients undergoing non-contrast cranial CT following blunt traumatic head injury from April 2006 to December 2015, at four emergency departments comprising community and university sites, as well as urban, suburban and rural settings in California (Antelope Valley Hospital, San Francisco General Hospital, UCLA Ronald Reagan Medical Center, UCSF Fresno Community Regional Medical Center). We classified each patient into one of three injury patterns: Type I-notable traumatic injuries primarily above the tentorium, with minimal posterior fossa involvement; Type II-notable traumatic injuries both above and within the posterior fossa; and Type III-notable traumatic injuries primarily within the posterior fossa. We extracted demographic data for each patient as well as physician assessments of the NEXUS head CT and Canadian Head CT rule clinical criteria, mechanisms of injury, patient outcomes, and the location and types of intracranial injuries sustained. Findings: Of 11,770 patients in the database, 184 (1.6%) had posterior fossa injuries on CT imaging. Mean age was 55.4 years (standard deviation 22.5 years, range 2-96 years); 131 (71.2%) were males. We identified 63 patients with Type I injuries, 87 with Type II injuries, and 34 Type III injuries. The most common mechanisms of injury were falls (41%), pedestrian vs automobile (15%), and motor vehicle collisions (13%). On presentation most patients had altered mental status (72%), abnormal behavior (53%), or a neurologic deficit (55%). The majority of individuals, 151 (82%), had clinically important injuries and 111 (60%) required neurosurgical intervention. The dispositions for the subjects included 52 deaths (28%), 49 (27%) patients discharged home, and 48 (26%) discharged to rehabilitation facilities. When compared to individuals with Type I and Type II injuries, patients with Type III injuries had lower mortality (6% vs 30% and 35%) and higher percentage of patients discharged home (60% vs 19% and 21%). Interpretation: Patients with Type I and II injury patterns (those that involve both the posterior fossa and supratentorium) experienced high mortality and disability. Patients with Type III injuries (isolated posterior fossa) had a better prognosis. Funding: None.
RESUMO
PURPOSE: The objective of this study is to compare two methods of preoperative planning for placement of intraocular implants: traditional paper documentation/electronic scans versus a novel online planning software. The aim was to compare the time required and number of data points manually transcribed with each method and to explore whether differences in surgical accuracy could be identified between the two methods in a small sample of 40 patients. METHODS: In this study, preoperative planning was performed twice for all enrolled patients: once through the traditional method and once using an online planning software system. The total time spent and number of data points manually transferred were recorded for each method. RESULTS: Of the 40 patients enrolled, the mean total surgical planning time was 239 ± 190 seconds for the traditional method vs 63 ± 31 seconds with the online planning software (P<0.00001). The mean number of data points transcribed was 7.2 ± 7.2 for the traditional method vs 0.9 ± 1.7 with the online planning software (P<0.0000001). No statistically significant differences were noted in terms of accuracy of prediction of the spherical equivalent surgical outcome. CONCLUSION: In comparison to traditional methods, a significant reduction in time required for surgical planning and the manual transcription of data points was noted when a comprehensive online surgical planning software was used. This has important implications for the efficiency and likely the safety of surgical planning.