Stress and strain propagation on infant skull from impact loads during falls: a finite element analysis.

Background and Objective: To simulate infant skull trauma after low height falls when variable degrees of ossification of the sutures are present. Methods: A finite elements model of a four-week-old infant skull was developed for simulating low height impact from 30 cm and 50 cm falls. Two impacts were simulated: An occipito-parietal impact on the lambdoid suture and a lateral impact on the right parietal and six cases were considered: unossified and fully ossified sutures, and sagittal, metopic, right lambdoid and right coronal craniosynostosis. Results: 26 simulations were performed. Results showed a marked increase in strain magnitudes in skulls with unossified sutures and fontanels. Higher deformations and lower Von Mises stress in the brain were found in occipital impacts. Fully ossified skulls showed less overall deformation and lower Von Mises stress in the brain. Results suggest that neonate skull impact when falling backward has a higher probability of resulting in permanent damage. Conclusion: This work shows an initial approximation to the mechanisms underlying TBI in neonates when exposed to low height falls common in household environments, and could be used as a starting point in the design and development of cranial orthoses and protective devices for preventing or mitigating TBI.

Perfil clínico-epidemiológico dos traumatismos cranioencefálicos atendidos em um hospital de referência do interior do estado do Ceará / Clinical and epidemiological profile of traumatisms cranioencephalics served in a reference hospital of the interior of the state of Ceará / Perfil clínico-epidemiológico de los traumatismos cranioencefálicos atendidos en un hospital de referencia del interior del estado del Ceará

Objetivo: Caracterizar os atendimentos às vítimas de Traumatismo Cranioencefálico de um hospital de referência do interior do Estado de Ceará. Método: trata-se de uma pesquisa exploratória-descritiva, de abordagem quantitativa, do tipo documental. A mesma foi realizada no Serviço de Arquivos Médico e Estatístico do referido hospital, através da análise dos prontuários de pacientes internados. Resultado: A partir da análise de 267 prontuários identificados entre os meses de janeiro a julho de 2018, pôde-se inferir que houve o predomínio de homens, com (88 %), com idade entre 21 a 40 anos (40,4%). As principais causas foram os acidentes envolvendo motocicleta (54,9%) e as quedas acidentais (19,2%). A maioria dos pacientes (71%) foram submetidos a um tratamento clínico. Conclusão: Dessa forma, o perfil encontrado sugere a importância da atuação do sistema de saúde local e estadual, de modo a possibilitar a criação e implantação de estratégia de prevenção e aprimoramento no atendi¬mento dos TCE.(AU)

Objective: To characterize the care of victims of Cranioencephalic Trauma of a reference hospital in the interior of the State of Ceará. Method: This is an exploratory-descriptive, quantitative, documentary-type research. The same was done at the Medical and Statistical Archives Service of the mentioned hospital, through the analysis of the medical records of hospitalized patients. Results: From the analysis of 267 records identified between January and July 2018, it was possible to infer that there was a predominance of men, with (88%), aged between 21 and 40 years (40.4%).The main causes were accidents involving motorcycle (54.9%) and accidental falls (19.2%). Most patients (71%) underwent clinical treatment. Conclusion: In this way, the profile found suggests the importance of the local and state health system, so as to enable the creation and implementation of a prevention and improvement strategy in the care of the TBI.(AU)

Objetivo: Caracterizar las atenciones a las víctimas de Traumatismo Craneoencefálico de un hospital de referencia del interior del Estado de Ceará. Método: se trata de una investigación exploratoria-descriptiva, de abordaje cuantitativo, del tipo documental. La misma fue realizada en el Servicio de Archivos Médico y Estadístico del referido hospital, a través del análisis de los prontuarios de pacientes internados. En el análisis de 267 prontuarios identificados entre los meses de enero a julio de 2018, se pudo inferir que hubo el predominio de hombres, con (88%), con edad entre 21 a 40 años (40,4%). Las principales causas fueron los accidentes involucrando motocicleta (54,9%) y las caídas accidentales (19,2%). La mayoría de los pacientes (71%) fueron sometidos a un tratamiento clínico. Conclusión: De esta forma, el perfil encontrado sugiere la importancia de la actuación del sistema de salud local y estadual, de modo a posibilitar la creación e implantación de estrategia de prevención y perfeccionamiento en el atendimiento de los TCE.(AU)

Effects of LATCH versus Available Seatbelt Installation of Rear Facing Child Restraint Systems on Head Injury Criteria for 6 Month Old Infants in Rear End Collisions.

OBJECTIVE: The Lower Anchor and Tethers for CHildren (LATCH) system was introduced in vehicles made after September 1, 2002 and intended to make installation of rear and forward-facing child safety seats easier. Due to the lack of rear impact testing of RFCRS required per the Federal Motor Vehicle Safety Standards (FMVSS), the purpose of this study was to explore the effects, if any, of installation method of RFCRS on the performance of commonly purchased makes and models of RFCRS. Specifically, we hypothesize that in a 48 km/h (29.8 MPH) rear-end collision, installation of RFCRS using the LATCH system will result in higher Head Injury Criteria (HIC) values when compared to using the available lap/shoulder seatbelt (Emergency Locking Retractor - ELR or Automatic Locking Retractor - ALR). METHODS: The test matrix included 36 rear impact sled tests conducted using 3 installation methods on 3 models of RFCRS: the Graco SnugRide® with and without the base, the Britax Chaperone with base-mounted anti-rebound bar, and the Evenflo Tribute®, a model of convertible rearward/forward facing restraint system used in the rearward facing mode. The seats were installed using the LATCH system, ELR lap/shoulder belts, or ALR lap/shoulder belts in seating positions 4 and 6 on a vehicle buck mounted to the sled test base. The infant seat and 6 month old CRABI anthropometric test device (ATD) installation methods were in accordance with standards set forth in the National Highway Traffic Safety Administration's (NHTSA) FMVSS No. 213, Child Restraint Systems. All tests were conducted on pneumatic controlled acceleration sled (HYGE, Inc., PA, USA) at 48 km/h. RESULTS: Installation of infant seat type RFCRS using the LATCH system resulted in higher HIC15 values when compared to using the available lap/shoulder seatbelt (ELR or ALR). The mean HIC15 values were most severe when infant seat type RFCRS were installed using LATCH (Graco SnugRide® HIC15 = 394 and Britax Chaperone HIC15 = 133) compared to using either ELR lap/shoulder belts (Graco SnugRide® HIC15 = 218 and Britax Chaperone HIC15 = 65) or ALR lap/shoulder belts (Graco SnugRide® HIC15 = 194 and Britax Chaperone HIC15 = 78). The installation method did not result in a statistically significant difference in HIC for the convertible type RFCRS (Evenflo Tribute®). In many of the tests, the ATD's head struck the seatback in which the RFCRS was installed. These head strikes resulted in the higher HIC15 scores recorded throughout the testing. CONCLUSIONS: The results of this study suggest that LATCH does not offer equal protection to lap/shoulder belts from head injuries in rear impacts when used with infant seat type RFCRS.

Diretrizes de atenção à reabilitação da pessoa com traumatismo cranioencefálico / Guidelines for the rehabilitation of individual with traumatic brain injury / Directrices para la atención a la rehabilitación de la persona con traumatismo cranioencefálico

elaboração das Diretrizes de Atenção à Reabilitação da Pessoacom TCE baseou-se na literatura atualizada sobre o tema. A buscafoi limitada às línguas inglesa, espanhola, francesa e portuguesa. Foirealizada por um grupo de especialistas, de reconhecimento nacionale internacional. A elaboração das diretrizes foi alcançada por meioda discussão dos resultados do levantamento bibliográfico e da trocapresencial do grupo acerca de suas experiências em relação ao TCE...

Prevención de las lesiones secundarias asociadas al traumatismo craneoencefálico grave en el medio extrahospitalario / Prevention of secondary lesions associated to serious cranioencephalic trauma in extra hospital environment

A pesar de los avances en tratamiento del traumatismo craneoencefálico, este continúa cobrando vidas y en otros casos dejando secuelas permanentes que no permiten la integración del individuo a la sociedad, ocasionan una situación psicológica inaceptable para el paciente y la familia, que en muchas ocasiones debe apartarse de su trabajo, lo que provoca una carga económica adicional que aunada a la enfermedad hacen la vida familiar extremadamente difícil. Se realizó una revisión bibliográfica con el objetivo de actualizar la conducta inicial en los pacientes con traumatismo craneoencefálico grave para prevenir las lesiones secundarias. Para ello, se llevó a cabo una revisión el tema en libros, documentos impresos y en línea, a partir de una búsqueda en las siguientes bases de datos: Pubmed, Registro Cochrane Central, Bireme, Ebsco, Mediclatina y Lilacs. Se seleccionaron los artículos científicos de forma que el total de ellos cumplieran con los siguientes criterios: el 70 por ciento correspondientes a los últimos cinco años y de estos el 75 por ciento a los últimos tres años. Se concluye que el tratamiento en la fase prehospitalaria es determinante para la evolución de los pacientes con traumatismo craneoencefálico grave, por tal motivo es necesaria una intervención rápida y adecuada para prevenir las lesiones secundarias(AU)

Although there have been advances in cranioencephalic treatment, it still continues covering lives and in other cases leaving permanent sequels not allowing the integration to society, leading to a psychological situation that patients and his/her relatives could not agree to; in cases they should leave their job causing an additional economical charge that joined to disease make the family life extremely difficult. We carried out a bibliographic review with the objective of updating the initial behavior in patients with serious cranioencephalic trauma to prevent secondary lesions. For that we reviewed the theme in books, printed and online documents searching for in the following databases: Pubmed, central Cochrane register. Bireme. Ebsco, Mediclatina and Lilacs. We chose the scientifc articles in such a way that all of them would fulfill the following criteria: 70 percent published in the last five years, and 75 percent of them during the last three years. We arrived to the conclusion that pre-hospital stage treatment is determinant for the evolution of patients with serious cranioencephalic trauma; for that reason it is necessary a fast and adequate intervention to prevent secondary lesions(AU)

Trauma craniano violento pediátrico: uma revisão da literatura / Abusive head trauma in children: a literature review

OBJETIVO: Fornecer uma revisão de literatura científica sobre trauma craniano violento pediátrico enquanto forma de maus-tratos físicos contra bebês e crianças, ressaltando prevalência, sinais e sintomas, consequências, fatores de risco para sua ocorrência e, principalmente, estratégias de prevenção. FONTES DOS DADOS: Revisão nas bases de dados MEDLINE, SciELO, LILACS e Web of Science no período de 2001 a 2012 utilizando os termos "síndrome do bebê sacudido" e "trauma craniano violento" em inglês, espanhol e português. SÍNTESE DOS DADOS: O trauma craniano violento é definido como a lesão ao crânio ou ao conteúdo intracraniano de um bebê ou criança menor de cinco anos devido a um impacto brusco intencional e/ou a uma sacudida violenta. Ocorre principalmente com bebês e crianças menores de um ano de idade, e pode resultar em consequências graves, desde deficiências físicas ou mentais até a morte. Apesar de haver sinais específicos para esta forma de maus-tratos, eles podem se confundir com doenças comuns em crianças ou traumas cranianos acidentais, sendo imprescindível o preparo clínico dos profissionais envolvidos na avaliação dos casos para o diagnóstico correto. As estratégias de prevenção devem incluir tanto a identificação precoce dos casos, como a educação parental sobre o desenvolvimento infantil, especialmente sobre o padrão de choro do bebê. CONCLUSÕES: Considerando a gravidade do trauma craniano violento pediátrico, é fundamental que estratégias de prevenção sejam implementadas e avaliadas no contexto brasileiro. Sugere-se que indicadores de sua incidência sejam pesquisados nacionalmente.

OBJECTIVE: To review the scientific literature on pediatric abusive head trauma as a form of physical abuse against infants and young children, highlighting the prevalence, signs and symptoms, consequences, risk factors for its occurrence, and prevention strategies. DATA SOURCE: The MEDLINE, SciELO, LILACS, and Web of Science databases from 2001 to 2012 were reviewed, using the terms "shaken baby syndrome" and "abusive head trauma" in English, Spanish, and Portuguese. DATA SYNTHESIS: Pediatric abusive head trauma is defined as injury to the skull or intracranial contents of a infant or child younger than 5 years due to intentional abrupt impact and/or violent shaking. It occurs mainly in infants and children under 1 year of age, and may result in severe consequences, from physical or mental disabilities to death. Although there are specific signs for this form of abuse, they can be mistaken for common illnesses in children or accidental head injury; thus, clinical training of professionals involved in the assessment of cases to attain the correct diagnosis is crucial. Prevention strategies should include early identification of cases, as well as parental education on child development, especially on the infant's crying pattern. CONCLUSIONS: Considering the severity of abusive head trauma in children, it is critical that prevention strategies be implemented and evaluated in the Brazilian context. It is suggested that its incidence indicators be assessed at the national level.

Abusive head trauma in children: a literature review.

OBJECTIVE: To review the scientific literature on pediatric abusive head trauma as a form of physical abuse against infants and young children, highlighting the prevalence, signs and symptoms, consequences, risk factors for its occurrence, and prevention strategies. DATA SOURCE: The MEDLINE, SciELO, LILACS, and Web of Science databases from 2001 to 2012 were reviewed, using the terms "shaken baby syndrome" and "abusive head trauma" in English, Spanish, and Portuguese. DATA SYNTHESIS: Pediatric abusive head trauma is defined as injury to the skull or intracranial contents of a infant or child younger than 5 years due to intentional abrupt impact and/or violent shaking. It occurs mainly in infants and children under 1 year of age, and may result in severe consequences, from physical or mental disabilities to death. Although there are specific signs for this form of abuse, they can be mistaken for common illnesses in children or accidental head injury; thus, clinical training of professionals involved in the assessment of cases to attain the correct diagnosis is crucial. Prevention strategies should include early identification of cases, as well as parental education on child development, especially on the infant's crying pattern. CONCLUSIONS: Considering the severity of abusive head trauma in children, it is critical that prevention strategies be implemented and evaluated in the Brazilian context. It is suggested that its incidence indicators be assessed at the national level.

Tomografía axial computarizada en los traumatismos encefalo-craneanos / Computerized axial tomography in encephalic-cranial trauma

El traumatismo encefalo craneano (TEC) constituye una entidad de observación habitual en la práctica médica general. Se ha observado un significativo incremento del trauma craneano moderado y severo en nuestro país, relacionado fundamentalmente con los accidentes automovilísticos. Este hecho convierte el traumatismo encéfalo craneano en una problemática de marcado impacto epidemiológico. En estos casos la tomografía axial computarizada (TAC) proporciona información rápida y no invasiva del tejido cerebral, así como la presencia de colecciones sanguíneas y fracturas. Por todo lo antes expuesto es que nos motivamos a realizar este trabajo. Se realizó un estudio descriptivo y retrospectivo de todos los pacientes atendidos en el Hospital Provincial Universitario Celia Sánchez Manduley de Manzanillo, con el diagnóstico por TAC de trauma cráneo-encefálico moderado y severo en el período comprendido entre enero-diciembre de 2008. El universo estuvo constituido por 105 pacientes. Se tuvieron en cuenta variables como: edad, sexo y resultados de la tomografía inicial, obteniéndose como resultados significativos, que el grupo de edad más afectado fue el comprendido entre 41-50 años, así como el sexo masculino. El hematoma subdural y los focos contusionales fueron las lesiones más frecuente. El hematoma epidural fue la lesión que más se asoció a fracturas, edema cerebral y efecto de masa de más de 5mm(AU)

The encephalic cranial trauma constitutes a habitual entity of observation in the general medical practice. It has been observed an outstanding increase of the moderated and severe cranial trauma in our country, mainly related to car accidents. This fact turns the encephalic cranial trauma into an epidemiologic problem. In this case the computerized axial tomography (CAT) offers fast and information of the brain tissue, like the presence of blood collections and fractures. For the aforesaid aspects we feel motivated to perform this job. It was performed a descriptive and retrospective research of all the patients that were assisted at Celia Sanchez Manduley province hospital in Manzanillo, diagnosed by CAT of moderated encephalic cranial trauma since January to December, 2008. The universe was made by 105 patients. There were taken into account some variables like: age, sex and results of the initial tomography, obtaining as outstanding results that the most affected group of age was included between 41 to 50 years, as well as the male sex. The subdural hematoma and contusional focus were the most frequent lesions. The epidural hematoma was more associated to fractures, brain edema and effect of mass with more than 5mm(EU)

Revisiting current strategies for primary prevention of motorcycle collisions in Jamaica.

Motorcycle Road Traffic Collisions place a heavy burden on emergency medical services in Jamaica. We explore the existing strategies and legislative policies that may prevent or reduce the severity of these injuries in Jamaica. This is an important aspect of health care as it may minimize the impact of these preventable injuries on the limited resources of the health services.

[Safety measures in traffic and hospital morbimortality in craniocerebral trauma in the Distrito Federal]. / As medidas de segurança no trânsito e a morbimortalidade intra-hospitalar por traumatismo craniencefálico no Distrito Federal.

BACKGROUND: The study analyzed the effectiveness of safety measures (seat belt, velocity control) in traffic. The parameters were the decrease in number and severity in head injury trauma (HIT). METHODS: Epidemiological study, based on the evaluation of secondary data about head injury. The data were analyzed between two periods, before (1992) and after (1997) measures implementation. RESULTS: We compared the indices (per 100.000 population) of victims in the two periods. In 1992 there were 125.5 victims, and in 1997 there were 155.8. From this total in group 1 we had 26.2 cases of HIT with 5.2 deaths, in 1997 we had 62.1 with 4.1 deaths. About severity: in the first period were 9.6 cases severe or moderate head injury, in group 2 there were 8.1 cases. CONCLUSIONS: There was an increase in the number of victims of HIT caused by automobile accidents in this period, however the severity of the trauma showed a small decrease, possibly security measures were not efficiently in reducing the number of cases but may have been successful in reducing deaths related to this accidents.

Aspectos epidemiológicos del trauma craneoencefálico menor pediátrico / Epidemiological aspects of minor pediatric head trauma

El comportamiento del traumatismo craneoencefálico menor no es bien conocido en nuestro territorio ni en el país. Estudiar algunas variables de interés relacionadas con este importante problema de salud es el objetivo de este trabajo. Se realizó un estudio descriptivo, retrospectivo y prospectivo de 403 pacientes menores de 15 años, atendidos por el diagnóstico de trauma craneoencefálico menor en el Hospital Carlos Manuel de Céspedes de Bayamo en el período comprendido entre el 1° de enero y el 31 de diciembre del año 2000. El sexo masculino (82 por ciento) y los pacientes entre 2 y 6 años (74,9 por ciento) fueron los grupos más afectados. Las caídas (41,19 por ciento) y los accidentes del tránsito (28,0 por ciento) fueron las causas más frecuentes de trauma. Los síntomas neurológicos más comunes fueron la combinación del vómito, la cefalea y la somnolencia (96,7 por ciento). Un pequeño por ciento de los casos atendidos tuvo manifestaciones vegetativas importantes. Solo dos pacientes (0,49 por ciento) tuvieron criterio neuroquirúrgico, ambos por fracturas deprimidas de cráneo. No hubo mortalidad directa por traumatismo craneoencefálico. La mayoría de los pacientes (99,76 por ciento) egresó con buenos resultados(AU)

Traumatismo craneoencefálico en niños: mecanismos de lesión, restauración cerebral y prevención / Head injury in children: mechanisms of damage, brain restoration, and preventive measures

Las lesiones traumáticas son un motivo frecuente de demanda de atención médica en los servicios de urgencias, correspondiendo a 25 por ciento de acuerdo a un estudio realizado en hospitales pediátricos de México, y de estas lesiones el traumatismo craneoencefálico (TCE) ocupa el segundo lugar (30 por ciento). El 20 por ciento de los sobrevivientes de TCE tienen discapacidades significativas. La lesión cerebral primaria refleja el daño en el momento del impacto, en contraste la lesión secundaria comprende todas las lesiones subsecuentes. La recuperación depende de diversos factores, que incluyen: edad, área comprometida del cerebro, cantidad de tejido afectado, rapidez del daño, mecanismos de reorganización cerebral, así como de factores ambientales y psicosociales. Esta recuperación está mediada por la plasticidad cerebral. Se calcula que cada año 31 por ciento de las vidas de niños y adolescentes podrían ser salvadas, a través de la aplicación de las estrategias comunes disponibles para prevenir la muerte por lesiones. En el presente trabajo se revisan los mecanismos de lesión y de restauración cerebral, así como las medidas de prevención más comunes, pretendiendo con su comprensión una intervención médica más razonable en los niños con TCE.

Traumatismo craneo-encefálico en el servicio de emergencia del Hospital Abel Gilbert Ponton de Guayaquil

El presente es un estudio retrospectivo realizado mediante la revisión de casos que ingresaron al servicio de emergencia del Hospital Abel Gilbert Pontón, presentando algún tipo de traumatismo cráneo encefálico, durante los años comprendidos entre 1990 y 1995, un total de 435 pacientes; 276 (63.45 por ciento) correspondió al sexo femenino; 199 (36.55 por ciento)al sexo masculino; en relación con la edad, el grupo que mayor porcentaje de pacientes de TCE presentó fue el comprendido entre 0 y 10 años con 285 (21.15 por ciento). Entre las causas, los accidentes de tránsito originaron el 50 por ciento de los casos, seguidos de caídas y golpes fortuitos con el 32.8 por ciento, siendo el principal factor presdisponente el alcohol con el 10.2 por ciento. El dato clínico más frecuente fue el déficit de conciencia con el 93 por ciento, seguido de las cefaleas con el 6 por ciento los hematomas subdurales unilaterales tuvieron un 4.3 por ciento y como secuelas las neurósis con el 5.59 por ciento. El área donde mayor porcentaje se atendieron pacientes fue en cirugía con un porcentaje de 54.48 por ciento, luego fue el área de pediatría con 29.20 por ciento. El 1.15 por ciento de los pacientes fallecieron...

Protección craneana: cascos de seguridad / Craneal protection: hard hats

No olvidemos la importancia de los cascos de seguridad cuando queremos prevenir lesiones en la cabeza a los trabajadores por impacto, penetración y choque eléctrico o quemaduras. Como los otros equipos de protección personal los cascos de seguridad necesitan estar en perfectas condiciones. Ellos deben cumplir con la normalización y, por lo tanto, estar libres de grietas y fallas en el arnés. Asegúrese de que sus trabajadores estén protegidos. (AU)

Protección craneana: cascos de seguridad / Craneal protection: hard hats

No olvidemos la importancia de los cascos de seguridad cuando queremos prevenir lesiones en la cabeza a los trabajadores por impacto, penetración y choque eléctrico o quemaduras. Como los otros equipos de protección personal los cascos de seguridad necesitan estar en perfectas condiciones. Ellos deben cumplir con la normalización y, por lo tanto, estar libres de grietas y fallas en el arnés. Asegúrese de que sus trabajadores estén protegidos.