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1.
Curr Sports Med Rep ; 19(1): 24-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31913920

RESUMO

Soft tissue injuries to the head and neck are a common occurrence in sports. These anatomical regions are somewhat predisposed because of the "athletic stance" that is utilized in many close-contact sports. Although appropriate use of protective equipment, including mouth guards, helmets, and face shields, has reduced the incidence and severity of these injuries, they still occur regularly. To provide appropriate medical care, one must possess adequate knowledge of the superficial and deep anatomical structures, fundamental knowledge and skill in regard to wound care, and awareness of potential poor outcomes related to lacerations of unique structures, such as the mouth, eye, or ear.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Faciais/diagnóstico , Lacerações/diagnóstico , Lesões do Pescoço/diagnóstico , Traumatismos em Atletas/terapia , Traumatismos Craniocerebrais/terapia , Traumatismos Faciais/terapia , Humanos , Lacerações/terapia , Lesões do Pescoço/terapia , Volta ao Esporte
2.
J Vet Emerg Crit Care (San Antonio) ; 29(5): 478-483, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31468694

RESUMO

OBJECTIVES: To examine the Animal Trauma Triage (ATT) and modified Glasgow Coma Scale (mGCS) scores as predictors of mortality in injured cats. DESIGN: Observational cohort study conducted September 2013 to March 2015. SETTING: Nine Level I and II veterinary trauma centers. ANIMALS: Consecutive sample of 711 cats reported on the Veterinary Committee on Trauma (VetCOT) case registry. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We compared the predictive power (area under receiver operating characteristic curve; AUROC) and calibration of the ATT and mGCS scores to their components. Overall mortality risk was 16.5% (95% confidence interval [CI], 13.9-19.4). Head trauma prevalence was 11.8% (n = 84). The ATT score showed a linear relationship with mortality risk. Discriminatory performance of the ATT score was excellent (AUROC = 0.87 [95% CI, 0.84-0.90]). Each ATT score increase of 1 point was associated with an increase in mortality odds of 1.78 (95% CI, 1.61-1.97, P < 0.001). The eye/muscle/integument category of the ATT showed the lowest discrimination (AUROC = 0.60). When this component, skeletal, and cardiac components were omitted from score calculation, there was no loss in discriminatory capacity compared with the full score (AUROC = 0.86 vs 0.87, respectively, P = 0.66). The mGCS showed fair performance overall for prediction of mortality, but the point estimate of performance improved when restricted to head trauma patients (AUROC = 0.75, 95% CI, 0.70-0.80 vs AUROC = 0.80, 95% CI, 0.70-0.90). The motor component of the mGCS showed the best predictive performance (AUROC = 0.71); however, the full score performed better than the motor component alone (P = 0.004). When assessment was restricted to patients with head injury (n = 84), there was no difference in performance between the ATT and mGCS scores (AUROC = 0.82 vs 0.80, P = 0.67). CONCLUSION: On a large, multicenter dataset of feline trauma patients, the ATT score showed excellent discrimination and calibration for predicting mortality; however, an abbreviated score calculated from the perfusion, respiratory, and neurologic categories showed equivalent performance.


Assuntos
Gatos/lesões , Traumatismos Craniocerebrais/veterinária , Escala de Coma de Glasgow/veterinária , Triagem/normas , Animais , Estudos de Coortes , Traumatismos Craniocerebrais/diagnóstico , Feminino , Escala de Coma de Glasgow/normas , Masculino , Valor Preditivo dos Testes , Curva ROC , Sistema de Registros , Reprodutibilidade dos Testes , Centros de Traumatologia
3.
World Neurosurg ; 130: 154-156, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301440

RESUMO

BACKGROUND: Intracranial de novo arachnoid cysts in adults are rare, suggesting the involvement of head trauma and inflammatory diseases. We report a symptomatic adult case of nontraumatic de novo arachnoid cyst on the ventral medulla oblongata. CASE DESCRIPTION: A 56-year-old man came to our hospital complaining of dysphagia and writing difficult since 3 months ago. There was no history of head injury or inflammatory disease. A 25-mm cystic lesion was found on the ventral side of the medulla oblongata on brain magnetic resonance imaging, and the lower cranial nerve and medulla oblongata were highly compressed. The lesion did not exist on magnetic resonance imaging performed 9 years ago. Capsular resection was performed, and the histologic diagnosis was a typical arachnoid cyst. After the operation, all neurologic symptoms disappeared and no recurrence has been observed after 6 months. CONCLUSIONS: The pathophysiology of nontraumatic de novo arachnoid cysts has many unknown features, and it appears necessary to accumulate further case reports.


Assuntos
Cistos Aracnóideos/patologia , Cistos Aracnóideos/cirurgia , Traumatismos Craniocerebrais/cirurgia , Bulbo/cirurgia , Recidiva Local de Neoplasia/cirurgia , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Bulbo/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Tomografia Computadorizada por Raios X/métodos
4.
Neurol India ; 67(3): 738-743, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31347546

RESUMO

Background: Posttraumatic movement disorders (PTMDs) are frequently associated with severe head injury. There are very few studies on the clinical phenomenology and radiological correlation of PTMD. Aims: To study the clinical phenomenology of patients with PTMD and correlate it with the site of lesion on brain imaging. Materials and Methods: This was a prospective study of patients with suspected PTMD. All of these patients underwent neurological evaluation to characterize the phenomenology and imaging, such as computed tomography/magnetic resonance imaging (CT/MRI), to localize the site of lesion. Results: The age of the patients was 32.6 ± 16.4 years and the age at onset was 29.1 ± 16.0 years. Right upper limb was the initial body part affected in 36.7% patients. Tremor (alone or with dystonia) was the most common movement disorder (MD; 44.7%) followed by parkinsonism (17.2%), dystonia (13.8%), dystonia plus (dystonia associated with choreoathetosis: 10.3%), mixed MD (more than one MD: 10.3%), and myoclonus (3.4%). MRI was performed in 23 patients and the rest seven patients underwent CT brain. Normal MRI was observed in one patient with parkinsonism. Isolated, discrete lesions were found in six (27.3%) patients. Basal ganglia was the most common site of involvement (66.7%) followed by thalamus (16.7%) and brainstem (16.7%). Diffuse white matter involvement was the most common radiological lesion in patients with tremor. Conclusions: Our study describes the clinical phenomenology of patients with PTMDs and its radiological correlation. Tremor (alone or in combination with dystonia) was the most common MD observed and diffuse white matter lesions without affection of the basal ganglia was the most common site of lesion.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Encéfalo/patologia , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico , Transtornos dos Movimentos/complicações , Transtornos dos Movimentos/diagnóstico , Adulto , Encéfalo/diagnóstico por imagem , Lesões Encefálicas Traumáticas/patologia , Traumatismos Craniocerebrais/patologia , Feminino , Humanos , Masculino , Transtornos dos Movimentos/patologia , Estudos Prospectivos
5.
BMC Emerg Med ; 19(1): 35, 2019 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200643

RESUMO

BACKGROUND: Many clinical predictive tools have been developed to diagnose traumatic brain injury among children and guide the use of computed tomography in the emergency department. It is not always feasible to compare tools due to the diversity of their development methodologies, clinical variables, target populations, and predictive performances. The objectives of this study are to grade and assess paediatric head injury predictive tools, using a new evidence-based approach, and to provide emergency clinicians with standardised objective information on predictive tools to support their search for and selection of effective tools. METHODS: Paediatric head injury predictive tools were identified through a focused review of literature. Based on the critical appraisal of published evidence about predictive performance, usability, potential effect, and post-implementation impact, tools were evaluated using a new framework for grading and assessment of predictive tools (GRASP). A comprehensive analysis was conducted to explain why certain tools were more successful. RESULTS: Fourteen tools were identified and evaluated. The highest-grade tool is PECARN; the only tool evaluated in post-implementation impact studies. PECARN and CHALICE were evaluated for their potential effect on healthcare, while the remaining 12 tools were only evaluated for predictive performance. Three tools; CATCH, NEXUS II, and Palchak, were externally validated. Three tools; Haydel, Atabaki, and Buchanich, were only internally validated. The remaining six tools; Da Dalt, Greenes, Klemetti, Quayle, Dietrich, and Güzel did not show sufficient internal validity for use in clinical practice. CONCLUSIONS: The GRASP framework provides clinicians with a high-level, evidence-based, comprehensive, yet simple and feasible approach to grade, compare, and select effective predictive tools. Comparing the three main tools which were assigned the highest grades; PECARN, CHALICE and CATCH, to the remaining 11, we find that the quality of tools' development studies, the experience and credibility of their authors, and the support by well-funded research programs were correlated with the tools' evidence-based assigned grades, and were more influential, than the sole high predictive performance, on the wide acceptance and successful implementation of the tools. Tools' simplicity and feasibility, in terms of resources needed, technical requirements, and training, are also crucial factors for their success.


Assuntos
Tomada de Decisão Clínica/métodos , Traumatismos Craniocerebrais/diagnóstico , Pediatria/instrumentação , Adolescente , Criança , Pré-Escolar , Medicina Baseada em Evidências , Humanos , Modelos Logísticos
6.
J Clin Neurosci ; 66: 12-18, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31155341

RESUMO

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease mainly involving central and peripheral motor neurons. The etiology of ALS is not clear. In China, there is a preliminary exploration of genetic factors, but the study on environmental factors is relatively inadequate, which needs to be further clarified. To investigate the protective or harmful effects of different environmental factors on ALS, and explore the possible etiology of ALS of the Chinese for further study. Case-control study were used in 123 patients and 239 healthy controls from 2013 to 2016. Statistical analysis and description were performed with SPSS24.0. The risk factors of ALS include head trauma (OR = 3.397, 95% [1.298, 8.893], P = 0.013), drinking (OR = 1.760, 95% CI [1.110,2.790], p = 0.016), smoking (OR = 3.196, 95% [1.375, 7.427], P = 0.351), low BMI (OR = 1.231, 95% CI [1.115, 1.319], P = 0.000), workers or famers (OR = 2.539, 95% [1.441,4.475], P = 0.001, 30-34 yrs); factors that reduce incidence of ALS including hypertension (OR = 0.526, 95% [0.313, 0.883], P = 0.015), severe physical activities (OR = 0.808, 95% [0.711, 0.918], P = 0.001), longer duration of education (OR = 0.183, 95% [0.078, 0.428], P = 0.000, >12 yrs), reading (OR = 0.225, 95% [0.126, 0.516], P = 0.000, 13-30 yrs), retirement or unemployment (OR = 0.040, 95% [0.005, 0.291], P = 0.000, 30-34 yrs); family history of neurologic disorder, general trauma, years and numbers of smoking, artistic activities, and other occupational factors did not show correlation with ALS. Head trauma, alcohol consumption, smoking, low BMI, workers or farmers are risk factors for ALS; high blood pressure, severe physical activity, longer duration of education, reading, retirement or unemployment are protective factors for ALS; whether there is a connection between ALS and family history, general trauma, years or numbers of smoking, artistic activities, and other occupational factors need to be confirmed by further study.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Esclerose Amiotrófica Lateral/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Fumar/efeitos adversos , Fumar/epidemiologia , Adulto , Idoso , Esclerose Amiotrófica Lateral/diagnóstico , Estudos de Casos e Controles , China/epidemiologia , Traumatismos Craniocerebrais/diagnóstico , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco
7.
Semin Pediatr Surg ; 28(3): 183-188, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31171155

RESUMO

Trauma is the leading cause of morbidity and mortality in the pediatric population. Due to a variety of factors, many pediatric trauma patients are initially evaluated and stabilized at adult hospitals that lack pediatric specific emergency medicine and surgical expertise. While similar to adult patients, the initial evaluation and resuscitation of pediatric patients does differ. Many of these key differences contribute to missed injury and susceptibility to error in the treatment of children. Here, we highlight a variety of differences between pediatric and adult trauma patients and clarify reasoning for these differences. Error traps that are discussed include missed cases of non-accidental trauma, missed blunt cerebrovascular injury, over use of CT (computed tomography) scans with unnecessary radiation exposure, missed small bowel or mesenteric injury, and unrecognized hemodynamic instability.


Assuntos
Lesões das Artérias Carótidas/diagnóstico , Maus-Tratos Infantis , Traumatismos Craniocerebrais/diagnóstico , Hipovolemia/diagnóstico , Intestinos/lesões , Erros Médicos , Segurança do Paciente , Medicina de Emergência Pediátrica/normas , Artéria Vertebral/lesões , Ferimentos não Penetrantes/diagnóstico , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Medicina de Emergência Pediátrica/métodos
9.
WMJ ; 118(1): 47-48, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31083836

RESUMO

INTRODUCTION: Abusive head trauma is a serious, often fatal condition; early identification is important to prevent repeat episodes and/or injuries to siblings. This case emphasizes the importance of a thorough workup in cases of suspected abusive head trauma. CASE PRESENTATION: A 4-month-old infant was found to have a severe subdural hematoma requiring surgical evacuation. Initially, abusive head trauma was considered as a diagnosis. Testing revealed vitamin K deficiency bleeding (VKDB) despite prophylactic vitamin K administration at birth. The infant eventually was diagnosed with progressive familial Iintrahepatic cholestasis type 2 (PFIC2). DISCUSSION: Although VKDB is a known cause of infantile intracranial hemorrhage, PFIC has not been previously reported to cause severe VKDB resulting in an intracranial hemorrhage. CONCLUSION: Our case illustrates the importance of a comprehensive systematic approach to investigate causes other than abusive head injury when intracranial bleeding is a significant finding.


Assuntos
Colestase Intra-Hepática/diagnóstico , Hematoma Subdural/diagnóstico , Maus-Tratos Infantis/diagnóstico , Colestase Intra-Hepática/tratamento farmacológico , Traumatismos Craniocerebrais/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Vitamina K/uso terapêutico
11.
J Surg Res ; 242: 177-182, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31078903

RESUMO

BACKGROUND: The aim of this study was to compare hospital outcomes for patients in a motorcycle collision with and without helmet use. The study was conducted as a retrospective analysis of the National Trauma Data Bank's 2013 data set, which included reported data from 100 hospitals across the United States. METHODS: Inclusion criterion for this study is a motorcycle crash involving a driver or passenger. The total number of patients in motorcycle crashes as reported by the National Trauma Data Bank in 2013 was 10,345. Helmet use, hospital stay, ICU and ventilation days, mortality, Glasgow Coma Score, Injury Severity Score, patient payer mix, and complication data were obtained. RESULTS: Patients were divided into two groups: those wearing a helmet (n = 6250) and those without (n = 4095). Patients not wearing a helmet had an increased risk of admission to the ICU (OR = 1.36, P < 0.001, CI 1.25-1.48), requiring ventilation support (OR = 1.55, P < 0.001, CI 1.39-1.72), presenting with a Glasgow Coma Score of eight or below (OR = 2.15, P < 0.001), and in-patient mortality (OR = 2.00, P < 0.001, CI 1.58-2.54). Unhelmeted patients were more likely to have government insurance or be uninsured than those patients wearing a helmet (P < 0.001). CONCLUSIONS: It is not well understood why many states are repealing or have repealed universal helmet laws. Lack of helmet use increases the severity of injury in traumatized patients leading to a substantial financial impact on health care costs. Our analysis suggests the need to revisit the issue regarding laws that require protective headwear while riding motorcycles because of the individual and societal impact. LEVEL OF EVIDENCE: III.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Craniocerebrais/economia , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Motocicletas/legislação & jurisprudência , Acidentes de Trânsito/economia , Acidentes de Trânsito/prevenção & controle , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/prevenção & controle , Bases de Dados Factuais/estatística & dados numéricos , Conjuntos de Dados como Assunto , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Motocicletas/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
12.
JAMA Pediatr ; 173(7): 648-656, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31081856

RESUMO

Importance: Computed tomographic (CT) scanning is the standard for the rapid diagnosis of intracranial injury, but it is costly and exposes patients to ionizing radiation. The Pediatric Emergency Care Applied Research Network (PECARN) rules for identifying children with minor head trauma who are at very low risk of clinically important traumatic brain injury (ciTBI) are widely used to triage CT imaging. Objective: To examine whether optimal classification trees (OCTs), which are novel machine-learning classifiers, improve on PECARN rules' predictive accuracy. Design, Setting, and Participants: A secondary analysis of prospective, publicly available data on emergency department visits for head trauma used by the PECARN group to develop their tool was conducted to derive OCT-based prediction rules for ciTBI in a development cohort and compare their predictive performance vs the PECARN rules in a validation cohort among children who were younger than 2 years and 2 years or older. Data on 42 412 children with head trauma and without severely altered mental status who were examined between June 1, 2004, and September 30, 2006, were gathered from 25 emergency departments in North America participating in PECARN. Data analysis was conducted from September 15, 2016, to December 18, 2018. Main Outcomes and Measures: The outcome was ciTBI, with predictive performance measured by estimating the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for the OCT and the PECARN rules. The OCT and PECARN rules' performance was compared by estimating ratios for each measure. Results: Of the 42 412 children (15 996 [37.7%] girls) included in the analysis, 10 718 were younger than 2 years (25.3%; mean [SD] age, 11.6 [0.6] months) and 31 694 were 2 years or older (74.7%; age, 9.1 [4.9] years). Compared with PECARN rules, OCTs misclassified 0 vs 1 child with ciTBI in the younger and 10 vs 9 children with ciTBI in the older cohort, and correctly identified more children with very low risk of ciTBI in the younger (7605 vs 5701) and older (20 594 vs 18 134) cohorts. In the validation cohorts, compared with the PECARN rules, the OCTs had statistically significantly better specificity (in the younger cohort: 69.3%; 95% CI, 67.4%-71.2% vs 52.8%; 95% CI, 50.8%-54.9%; in the older cohort: 65.6%; 95% CI, 64.5%-66.8% vs 57.6%; 95% CI, 56.4%-58.8%), positive predictive value (odds ratios, 1.54; 95% CI, 1.36-1.74 and 1.23; 95% CI, 1.17-1.30, in younger and older children, respectively), and positive likelihood ratio (risk ratios, 1.54; 95% CI, 1.36-1.74 and 1.23; 95% CI, 1.17-1.30, in younger and older children, respectively). There were no statistically significant differences in the sensitivity, negative predictive value, and negative likelihood ratio between the 2 sets of rules. Conclusions and Relevance: If implemented, OCTs may help reduce the number of unnecessary CT scans, without missing more patients with ciTBI than the PECARN rules.


Assuntos
Traumatismos Craniocerebrais/classificação , Técnicas de Apoio para a Decisão , Serviços Médicos de Emergência/métodos , Serviço Hospitalar de Emergência , Aprendizado de Máquina , Triagem/métodos , Adolescente , Criança , Pré-Escolar , Traumatismos Craniocerebrais/diagnóstico , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Índices de Gravidade do Trauma
13.
J Headache Pain ; 20(1): 34, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961529

RESUMO

BACKGROUND: Head trauma has been described as a precipitating event in Nummular Headache (NH). We aimed to describe the largest NH published series and compare characteristics between idiopathic and post-traumatic cases. METHODS: Patients attended in a Headache Unit in a tertiary hospital (January 2008-January 2018). NH diagnosed according to International Classification of Headache Disorders (ICHD) criteria. We prospectively considered clinical and epidemiological data, comparing idiopathic cases with those precipitated by a cranial trauma. RESULTS: We included 225 patients (145 women, 80 men) with NH. Median latency between onset and diagnosis was 10 months (IQR: 5-24). Symptomatic treatment was used in 190 patients (84.4%) among which 142 (74.7%) experienced response to it. Preventive treatment was necessary in 127 patients (51.4%), among which 95 (74.8%) achieved response. 29 patients (23 women, 6 men) described a head trauma related to beginning of pain. When comparing groups with or without previous trauma, age of onset was higher among post-traumatic patients (59.9 ± 17.4 vs 48.1 ± 18 years, p: 0.001). Allodynia upon palpation was encountered more frequently in trauma triggered painful areas (53.3% vs. 32.7%, p: 0.02). No other clinical characteristics differences were observed. CONCLUSION: Cranial trauma is not a rare trigger of NH. Patients with post-traumatic forms are older and the presence of allodynia is more frequent.


Assuntos
Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/epidemiologia , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/epidemiologia , Adulto , Idoso , Traumatismos Craniocerebrais/psicologia , Feminino , Transtornos da Cefaleia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Centros de Atenção Terciária , Adulto Jovem
14.
BMJ Case Rep ; 12(4)2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30948403

RESUMO

Trapdoor fractures, otherwise known as 'white-eyed blowout' fractures, occur predominantly in the paediatric cohort and have a male predilection. Patients commonly present with acute fractures to the emergency department, and delayed diagnosis can result in significant morbidity. A lack of external signs, such as oedema or ecchymosis, often misleads physicians into underestimating the seriousness of the injury. It can be initially misdiagnosed as a head injury due to the oculocardiac reflex, nausea, vomiting, poor patient compliance and a failure to examine the eye appropriately. The incarcerated muscles may become necrotic because of ischaemia, resulting in ocular motility problems. Immediate surgery is recommended for symptomatic persistent diplopia or clinical evidence of muscle entrapment. The authors present the case of a 16-year-old male adolescent initially diagnosed with a head injury due to his nausea and vomiting following trauma to his orbit. This resulted in a delay to surgery. This article highlights the importance of performing an ophthalmic assessment to detect other features of a trapdoor fracture in children presenting with orbital trauma. It also reinforces the importance of knowledge of the oculocardiac reflex as its association with orbital injuries is well documented.


Assuntos
Traumatismos Craniocerebrais/diagnóstico , Fraturas Orbitárias/diagnóstico , Adolescente , Diagnóstico Diferencial , Erros de Diagnóstico , Humanos , Masculino
15.
Arch Pediatr ; 26(4): 199-204, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30954367

RESUMO

OBJECTIVE: To assess the knowledge of professionals on abusive head trauma (AHT) and shaking so as to adapt their training and thus promote the improvement of AHT screening and prevention. METHOD: A questionnaire was developed on the knowledge of the intensity of movement, the frequency of repetition, the existence and progression of sequelae over time, the legal nature of AHT as a criminal offence leading to the possibility of compensation, and the existence of HAS (French National Authority for Health) recommendations on shaken baby diagnosis and legal consequences. RESULTS: Over a 4-year period 311 physicians, 123 magistrates, and 644 early childhood professionals responded to the questionnaire as an introduction to a course on AHT. Whatever the professional field, incorrect answers (wrong or "I don't know") were frequent as to the possibility that play could induce AHT lesions (51-58%), the violence of the act (43-52%), the repetition of shaking (58-82.5%), the presence of side effects (52-58%), and the existence of recommendations to professionals (48-58.5%). Twenty to 47% of physicians and early childhood professionals were unaware that shaking a baby was a criminal offence and 20-27% were unaware that AHT required a report to the judicial authorities. DISCUSSION/CONCLUSION: This lack of knowledge about AHT is detrimental to the child. The improvement of initial and continuing education is necessary to help reduce the dysfunctions existing in the care of child victims of AHT.


Assuntos
Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/legislação & jurisprudência , Competência Clínica , Traumatismos Craniocerebrais/diagnóstico , Competência Profissional , Síndrome do Bebê Sacudido/diagnóstico , França , Humanos , Lactente , Notificação de Abuso , Inquéritos e Questionários
16.
J Sci Med Sport ; 22(7): 784-789, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31000457

RESUMO

OBJECTIVES: To assess the utility and functionality of the X-Patch® as a measurement tool to study head impact exposure in Australian Football. Accuracy, precision, reliability and validity were examined. DESIGNS: Laboratory tests and prospective observational study. METHODS: Laboratory tests on X-Patch® were undertaken using an instrumented Hybrid III head and neck and linear impactor. Differences between X-Patch® and reference data were analysed. Australian Football players wore the X-Patch® devices and games were video-recorded. Video recordings were analysed qualitatively for head impact events and these were correlated with X-Patch® head acceleration events. Wearability of the X-Patch® was assessed using the Comfort Rating Scale for Wearable Computers. RESULTS: Laboratory head impacts, performed at multiple impact sites and velocities, identified significant correlations between headform-measured and device-measured kinematic parameters (p<0.05 for all). On average, the X-Patch®-recorded peak linear acceleration (PLA) was 17% greater than the reference PLA, 28% less for peak rotational acceleration (PRA) and 101% greater for the Head Injury Criterion (HIC). For video analysis, 118 head acceleration events (HAE) were included with PLA ≥30g across 53 players. Video recordings of X-Patch®-measured HAEs (PLA ≥30g) determined that 31.4% were direct head impacts, 9.3% were indirect impacts, 44.1% were unknown or unclear and 15.3% were neither direct nor indirect head impacts. The X-Patch® system was deemed wearable by 95-100% of respondents. CONCLUSIONS: This study reinforces evidence that use of the current X-Patch® devices should be limited to research only and in conjunction with video analysis.


Assuntos
Acelerometria/instrumentação , Concussão Encefálica/diagnóstico , Traumatismos Craniocerebrais/diagnóstico , Futebol/lesões , Gravação em Vídeo/instrumentação , Dispositivos Eletrônicos Vestíveis , Adulto , Austrália , Feminino , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes
17.
Medicine (Baltimore) ; 98(17): e15443, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027147

RESUMO

RATIONALE: Plasmacytoma as the 1st presentation of skull tumors is a rare disorder. When it is combined with brain trauma or dramatic changes in intracranial pressure, patients are more prone to misdiagnosis. PATIENT CONCERNS: A 67-year-old woman complaining of a headache presented with a history of head trauma for the past 1 hour. Emergency head computed tomography initially suggested an epidural hematoma. DIAGNOSIS: Emergency surgery was performed to remove the intracranial hematoma, but a tumor-like mass was found during surgery, and pathologic assessment confirmed plasmacytoma. Surgery was difficult because of bleeding. The tumor was radically removed. INTERVENTIONS AND OUTCOMES: The patient underwent whole-brain radiotherapy and chemotherapy. She died 40 months after the surgery. LESSONS: Epidural lesions found after a head injury may be assumed to be an epidural hematoma, leading to unnecessary surgery. Diseases such as hematomas, meningiomas, eosinophilic granulomas, bone metastases, and osteosarcomas must be considered.


Assuntos
Traumatismos Craniocerebrais/diagnóstico , Hematoma Epidural Craniano/diagnóstico , Plasmocitoma/diagnóstico , Neoplasias Cranianas/diagnóstico , Idoso , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/terapia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Hematoma Epidural Craniano/cirurgia , Humanos , Plasmocitoma/patologia , Plasmocitoma/terapia , Neoplasias Cranianas/patologia , Neoplasias Cranianas/terapia
18.
Rev. medica electron ; 41(2): 368-381, mar.-abr. 2019. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1004274

RESUMO

RESUMEN Introducción: el traumatismo encefalocraneano es una causa frecuente de mortalidad y morbilidad. Según datos epidemiológicos aporta la mayor cantidad de fallecidos en menores de 45 años a nivel mundial. Objetivo: caracterizar el trauma craneoencefálico desde el punto de vista clínico-quirúrgico, neuroimagenológico y por neuromonitorización en los pacientes investigados. Materiales y métodos: estudio observacional, descriptivo, transversal, en el Servicio de Neurocirugía del Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane y Comandante Faustino Pérez Hernández, de Matanzas, durante el periodo comprendido entre enero del 2016 a enero del 2018. Resultados: predominó el sexo masculino con el 71,7% de los casos, la mayor prevalencia estuvo en edades inferiores a 48 años con el 80,1 %. La mayor cantidad presentaba un traumatismo encefalocraneano leve con el 56% de los casos seguido del traumatismo encefalocraneano moderado y severo con el 29% y 15% de los casos respectivamente. Predominaron las fracturas lineales (45,8%), seguido de las contusiones sin efecto de masa y los hematomas subdurales con el 24,2% y 23,3%. La mayoría de los pacientes presentó una escala de Marshall II con el 40,8%. Las cifras de presión intracraneal entre de 20-40 mmHg se presentó con mayor frecuencia (44,4 %). Conclusiones: la mitad de los pacientes neuromonitorizados presentaron una saturación del golfo de la vena yugular dentro de parámetros normales con el 50%. La operación más practicada fue la evacuación de hematomas subdurales con el 29,4%.


ABSTRACT Introduction: the encephalocranial trauma (ECT) is a frequent cause of mortality and morbidity. According to epidemiological data, it causes the highest number of deaths in people aged less than 45 years worldwide. Objective: to characterize the encephalocranial trauma from the clinical-surgical, neuroimaging and neuromonitoring point of view in the studied patients. Materials and methods: observational, descriptive, cross-sectional study carried out in the Neurosurgery Service of the Provincial Teaching Surgical Clinical Hospitals "Jose Ramon Lopez Tabrane" and "Comandante Faustino Perez Hernandez", of Matanzas, during the period from January 2016 to January 2018. Results: male sex predominated with 71.7% of the cases; the highest prevalence was in ages below 48 years with 80.1%. Most of them presented a mild encephalocranial trauma with 56% of the cases followed by moderate and severe encephalocranial trauma with 29% and 15% of the cases respectively. Linear fractures predominated (45.8%), followed by contusions without mass effect and subdural hematomas with 24.2% and 23.3%. Most of patients presented a Marshall II scale with 40.8%. The intracranial pressure between 20-40 mmHg occurred more frequently (44.4%). Conclusions: half of the neuromonitored patients presented jugular vein gulf saturation within normal parameters with 50%. The most practiced operation was the evacuation of subdural hematomas with 29.4%.


Assuntos
Humanos , Procedimentos Neurocirúrgicos , Tomografia Computadorizada Espiral , Traumatismos Craniocerebrais/cirurgia , Traumatismos Craniocerebrais/classificação , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Epidemiologia Descritiva , Estudos Transversais , Estudo Observacional , Traumatismos Craniocerebrais/diagnóstico
19.
Pediatr Surg Int ; 35(7): 785-791, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30891642

RESUMO

PURPOSE: Trending the pediatric-adjusted shock index (SIPA) after admission has been described for children suffering severe blunt injuries (i.e., injury severity score (ISS) ≥ 15). We propose that following SIPA in children with moderate blunt injuries, as defined by ISS 10-14, has similar utility. METHODS: The trauma registry at a single institution was queried over a 7 year period. Patients were included if they were between 4 and 16 years old at the time of admission, sustained a blunt injury with an ISS 10-14, and were admitted less than 12 h after their injury (n = 501). Each patient's SIPA was then calculated at 0, 12, 24, 36, and 48 h (h) after admission and then categorized as elevated or normal at each time frame based on previously reported values. Trends in outcome variables as a function of time from admission for patients with an abnormal SIPA to normalize as well as patients with a normal admission SIPA to abnormal were analyzed. RESULTS: In patients with a normal SIPA at arrival, elevation within the first 24 h of admission correlated with increased length of stay (LOS). Increased transfusion requirement, incidence of infectious complications, and need for in-patient rehabilitation were also seen in analyzed sub-groups. An elevated SIPA at arrival with increased length of time to normalize SIPA correlated with increased length of stay LOS in the entire cohort and in those without head injury, but not in patients with a head injury. No deaths occurred within the study cohort. CONCLUSIONS: Patients with an ISS 10-14 and a normal SIPA at time of arrival who then have an elevated SIPA in the first 24 h of admission are at increased risk for morbidity including longer LOS and infectious complications. Similarly, time to normalize an elevated admission SIPA appears to directly correlate with LOS in patients without head injuries. No correlations with markers for morbidity could be identified in patients with a head injury and an elevated SIPA at arrival. This may be due to small sample size, as there were no relations to severity of head injury as measured by head abbreviated injury scale (head AIS) and the outcome variables reported. This is an area of ongoing analysis. This study extends the previously reported utility of following SIPA after admission into milder blunt injuries.


Assuntos
Traumatismos Craniocerebrais/complicações , Unidades de Terapia Intensiva/estatística & dados numéricos , Sistema de Registros , Choque/epidemiologia , Ferimentos não Penetrantes/complicações , Criança , Traumatismos Craniocerebrais/diagnóstico , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Humanos , Indiana/epidemiologia , Escala de Gravidade do Ferimento , Tempo de Internação/tendências , Masculino , Morbidade/tendências , Choque/etiologia , Ferimentos não Penetrantes/diagnóstico
20.
Mil Med ; 184(Suppl 1): 237-244, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901450

RESUMO

Blunt impact assessment of the Advanced Combat Helmet (ACH) is currently based on the linear head response. The current study presents a methodology for testing the ACH under complex loading that generates linear and rotational head motion. Experiments were performed on a guided, free-fall drop tower using an instrumented National Operating Committee for Standards on Athletic Equipment (NOCSAE) head attached to a Hybrid III (HIII) or EuroSID-2 (ES-2) dummy neck and carriage. Rear and lateral impacts occurred at 3.0 m/s with peak linear accelerations (PLA) and peak rotational accelerations (PRA) measured at the NOCSAE head center-of-gravity. Experimental data served as inputs for the Simulated Injury Monitor (SIMon) computational model to estimate brain strain. Rear ACH impacts had 22% and 7% higher PLA and PRA when using the HIII neck versus the ES-2 neck. Lateral ACH impacts had 33% and 35% lower PLA and PRA when using HIII neck versus the ES-2 neck. Computational results showed that total estimated brain strain increased by 25% and 76% under rear and lateral ACH impacts when using the ES-2 neck. This methodology was developed to simulate complex ACH impacts involving the rotational head motion associated with diffuse brain injuries, including concussion, in military environments.


Assuntos
Traumatismos Craniocerebrais/classificação , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Simulação de Paciente , Aceleração/efeitos adversos , Fenômenos Biomecânicos , Simulação por Computador , Traumatismos Craniocerebrais/diagnóstico , Dispositivos de Proteção da Cabeça/normas , Humanos , Guerra , Wisconsin
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