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PubMed2003

Basilar artery thrombosis in a trauma patient. Case report and review of the literature.

Thrombotic disease of the vertebrobasilar circulation is associated with a poor prognosis. It may occur in trauma patients, especially those with neck injuries and even several months after the initial insult. We report on the case of a young polytrauma patient, victim of a traffic accident, with associated cervical and thoracic spinal injuries resulting in paraplegia. Consciousness was not impaired initially, but during transfer to our hospital he became suddenly unconscious. An occluded basilar artery was found on angiography, but unfortunately we were unable to reopen the vessel with thrombolytic therapy. This case again proves that lesions of the vertebro-basilar system must always be suspected in neck injuries. Even after minor whiplash injuries, fatal basilar thrombosis may occur. A review of all reported cases of traumatic basilar artery thrombosis is given and the use of thrombolytic therapy is discussed.

Accidents, Traffic↗
PubMed1991

Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma.

Minor trauma to the head or neck is occasionally followed by severe chronic headaches. We have evaluated 35 adults (27 women, 8 men) with no prior history of headaches, who developed recurrent episodic attacks typical of common or classic migraine following minor head or neck injuries ("post-traumatic migraine"-PTM). The median age of these patients was 38 years (range 17 to 63 years), which is older than the usual age at onset of idiopathic migraine. The trauma was relatively minor: 14 patients experienced head trauma with brief loss of consciousness, 14 patients sustained head trauma without loss of consciousness, and 7 patients had a "whiplash" neck injury with no documented head trauma. Headaches began immediately or within the first few days after the injury. PTM typically recurred several times per week and was often incapacitating. The patients had been unsuccessfully treated by other physicians, and there was a median delay of 4 months (range 1 to 30 months) before the diagnosis of PTM was suspected. The response to prophylactic anti-migraine medication (propranolol or amitriptyline used alone or in combination) was gratifying, with 21 of 30 adequately treated patients (70%) reporting dramatic reduction in the frequency and severity of their headaches. Improvement was noted in 18 of the 23 patients (78%) who were still involved in litigation at the time of treatment. The neurologic literature has placed excessive emphasis on compensation neurosis and psychological factors in the etiology of chronic headaches after minor trauma. Physicians must be aware of PTM, as it is both common and treatable.

Adolescent↗
PubMed1985

Assessment of bullet injuries in the neck (a salutory lesson).

Bullet injuries in the neck are fortunately rare in England and Wales, although their incidence is increasing. Clinical assessment of the extent of the injury and the decision whether or not to explore the neck in the absence of obvious major visceral or vascular damage can be difficult. We report a case where a potentially fatal injury was not suggested by the patient's clinical condition and we recommend prompt exploration of bullet wounds in the neck whenever there is a possibility of vascular damage.

Adult↗
PubMed2006

Emergency department visits for sledding injuries in children in the United States in 2001/2002.

OBJECTIVES: To describe the characteristics of nonfatal sledding-related injuries in U.S. children resulting in emergency department (ED) visits in 2001/2002 and to explore the implications of these findings for injury prevention efforts. METHODS: A stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System-All Injury Program was utilized for 2001/2002. ED visits resulting from injuries involving sleds, snow discs, snow tubes, and toboggans were analyzed for patients 19 years of age or younger. RESULTS: In 2001/2002, there were an estimated 57,866 ED visits for sledding-related injuries in the United States for all age groups. Of these, 41,272 (71%) occurred in patients 19 years of age or younger, 58% of whom were male. The highest number of injuries occurred in children between five and 14 years of age (74%), and the injuries were most often caused by falls or collisions (75%). The head or neck was the most frequently injured body region among those 0-9 years of age, while the extremities were injured most commonly among those 10-19 years of age. Head and neck injuries occurred in 56% (95% confidence interval [CI] = 32% to 81%) of children 0-4 years of age versus 19% (95% CI = 9% to 29%) of patients 15-19 years of age. Nine percent (95% CI = 6% to 12%) of patients sustained a traumatic brain injury. Three percent (95% CI = 1% to 5%) of patients required admission to the hospital. CONCLUSIONS: Sledding injuries resulting in ED visits predominantly affect children and are a source of measurable morbidity in this population. An increase in injury prevention efforts for this activity is warranted.

Adolescent↗
PubMedDate not supplied

[Significance of associated causes in the evaluation of post-traumatic vestibular damage].

Any evaluation of vestibular diseases following head and neck injuries must take into consideration the existence of other diseases which may act with the trauma causing lesions which might not have taken place otherwise or which would have had less import. In the present work the authors examine what medico-legal doctrine considers in regard to pre-existing, simultaneous and cropped up aggravations of lesions or of invalidity. Finally, an explanation is given of personal experience with 1500 patients with head and neck injury. It is pointed out how in 130 cases the presence of pathological conditions associated with the traumatic event was the cause of problems in evaluation of primary importance.

Accidents, Occupational↗
PubMed1999

Traumatic dissection of the common carotid artery after blunt injury to the neck.

BACKGROUND: Occlusive lesions of the common carotid artery (CCA) resulting from blunt injury are extremely rare, and their clinicopathologic and therapeutic features have not yet been clarified. OBJECTIVES AND RESULTS: Five patients with occlusive lesions of the CCA developed neurologic deficits at 1.5 hours to 10 years after blunt neck injury. Lesions included two complete occlusions, one severe stenosis, and two segmental intimal dissections of the CCA. In the two patients with CCA occlusion, bypass surgery was performed using a Dacron graft between the ipsilateral subclavian artery and the carotid bifurcation. In the remaining three patients, the involved segments were replaced with a Dacron graft. Surgical specimens from the early posttraumatic period revealed intimal tears with mural thrombosis and/or subintimal hematomas and those from the later period showed myointimal hyperplasia or fibrotic organization. CONCLUSION: Traumatic occlusive lesions of the CCA tend to evolve from intimal dissections to severe stenoses or occlusion, compromising cerebral circulation. The involved CCA can be diagnosed early by B-mode Doppler sonography and successfully reconstructed using a Dacron graft.

Adult↗
PubMed2004

Do people who were passive smokers during childhood have increased risk of long-term work disability? A 15-month prospective study of nurses' aides.

BACKGROUND: Regular inhalation of tobacco smoke, whether it be voluntary or not, may have profound negative effects on the body. Also intervertebral discs may be affected. The objective of the present study was to test the hypothesis that nurses' aides who were exposed to environmental tobacco smoke (ETS) at home during childhood have an increased risk of long-term sick leave. METHODS: The sample comprised 5563 Norwegian nurses' aides, not on sick leave when they completed a mailed questionnaire in 1999. Of these, 4744 (85.3%) completed a second questionnaire 15 months later. The outcome measure was the incidence proportion of long-term sick leave during the 12 months prior to the follow-up. RESULTS: Respondents who reported at baseline that they had been exposed to ETS at home during childhood had increased risk of sick leave exceeding 14 days attributed to neck pain (odds ratio (OR) = 1.34; 95% confidence interval (CI): 1.04-1.73), high back pain (OR=1.49; CI: 1.07-2.06), low back pain (OR=1.21; CI: 0.97-1.50), and any illness (OR=1.23; CI: 1.07-1.42), after adjustments for demographic and familial characteristics, former smoking, current smoking, physical leisure-time activities, work factors, prior neck injury, and affective symptoms. They also had increased risk of sick leave exceeding 8 weeks (OR=1.29; CI: 1.08-1.55). CONCLUSION: The study supports the hypothesis that nurses' aides who were exposed to ETS at home during childhood have an increased risk of long-term sickness absence.

Adult↗
PubMed1988

Stairway injuries in children.

Children frequently injure themselves falling down stairways, but the characteristics of these injuries are not well described. A total of 363 consecutive patients seen in a pediatric emergency department were studied. The majority of patients had minor superficial injuries. Bony injuries occurred in 7% of patients. Head and neck injuries occurred in 73% of patients, extremity injuries, which were predominantly distal, in 28%, and truncal injuries in 2%. Children younger than 4 years of age were more likely to sustain head trauma than children older than 4 years of age (P less than .005). Injury to more than one body part occurred in only 2.7% of patients. Children who fell down more than four steps had no greater number or severity of injury than those who fell down less than four steps (P = .67). Patients were admitted to hospitals in 3% of cases. No patient had life-threatening injuries and no patients required intensive care. When multiple, severe, truncal, or proximal extremity injuries are noted in a patient who reportedly fell down stairs, a different mechanism of injury should be suspected.

Accidental Falls↗
PubMed2006

Cervical vertigo and dizziness after whiplash injury.

Whiplash injury is not only limited to neck injury but also brainstem injury that does not involve direct damage to the neck or head. The symptoms of whiplash injury are polymorphous, with the most common complaints being cervical pain, headache and scapulodynia. Vertigo and dizziness are also reported in 25-50% of the cases. In otoneurologic studies, magnetic resonance angiography (MRA) is used for the evaluation of vertebrobasilar hemodynamics in patients who complain of dizziness and vertigo. It is reported that vertebrobasilar artery insufficiency (VBI) leads to brainstem and cerebellar ischemia and infarction following cervical manipulation. Here we examined the correlation between vertigo or dizziness and the right and left side difference in vertebral arteries after whiplash injury using MRA. We studied 20 patients who complained of neck pain with vertigo or dizziness after whiplash injury and 13 healthy volunteers as a control. In the control group, abnormal MRA findings in the vertebral arteries such as occlusion, stenosis or slow blood flow were seen in 77% of the cases. In the patient group, abnormal MRA findings were seen in 60%. The side difference in blood flow was 3.5+/-2.5 cm/s in the control group and 6.1+/-3.0 cm/s in the patient group. Our findings suggest that some subjects with persistent vertigo or dizziness after whiplash injury are more likely to have VBI on MRA. VBI might be an important background factor to evoke cervical vertigo or dizziness after whiplash injury. The side difference between the two vertebral arteries could cause a circulation disorder in the vertebrobasilar system after whiplash injury. However, the VBI on MRA itself was also seen in the control group, and thus it is not clear whether it is due to whiplash injury in the patient group.

Adult↗
PubMed2004

Penetrating injuries of the neck and the increasing role of CTA.

Vascular injuries of the neck are most frequently the result of penetrating trauma. Diagnostic evaluation of hemodynamically stable patients who have suffered penetrating neck wounds is challenging and remains controversial. In order to reduce morbidity and mortality, prompt diagnosis and subsequent treatment of these injuries is critical. Traditionally, these patients undergo direct contrast angiography. However, this technique has limitations including its invasive nature and potential complications. The use of routine screening angiography has also been questioned because of the low rate of positive examinations. More recently, helical and multislice CT angiography (CTA) has emerged as a fast, minimally invasive accurate study to evaluate penetrating neck injuries. CTA is not operator-dependent and the results can be reproduced easily by using established technical parameters. It is readily available in most centers and allows the simultaneous evaluation of the extravascular soft tissues and bones.

Angiography↗
PubMed2001

Penetrating esophageal injuries: multicenter study of the American Association for the Surgery of Trauma.

OBJECTIVE: The purpose of this study was to define the period of time after which delays in management incurred by investigations cause increased morbidity and mortality. The outcome study is intended to correlate time with death from esophageal causes, overall complications, esophageal related complications, and surgical intensive care unit length of stay. METHODS: This was a retrospective multicenter study involving 34 trauma centers in the United States, under the auspices of the American Association for the Surgery of Trauma Multi-institutional Trials Committee over a span of 10.5 years. Patients surviving to reach the operating room (OR) were divided into two groups: those that underwent diagnostic studies to identify their injuries (preoperative evaluation group) and those that went immediately to the OR (no preoperative evaluation group). Statistical methods included Fisher's exact test, Student's T test, and logistic regression analysis. RESULTS: The study involved 405 patients: 355 male patients (86.5%) and 50 female patients (13.5%). The mean Revised Trauma Score was 6.3, the mean Injury Severity Score was 28, and the mean time interval to the OR was 6.5 hours. There were associated injuries in 356 patients (88%), and an overall complication rate of 53.5%. Overall mortality was 78 of 405 (19%). Three hundred forty-six patients survived to reach the OR: 171 in the preoperative evaluation group and 175 in the no preoperative evaluation group. No statistically significant differences were noted in the two groups in the following parameters: number of patients, age, Injury Severity Score, admission blood pressure, anatomic location of injury (cervical or thoracic), surgical management (primary repair, resection and anastomosis, resection and diversion, flaps), number of associated injuries, and mortality. Average length of time to the OR was 13 hours in the preoperative evaluation group versus 1 hour in the no preoperative evaluation group (p < 0.001). Overall complications occurred in 134 in the preoperative evaluation group versus 87 in the no preoperative evaluation group (p < 0.001), and 74 (41%) esophageal related complications occurred in the preoperative evaluation group versus 32 (19%) in the no preoperative evaluation group (p = 0.003). Mean surgical intensive care unit length of stay was 11 days in the preoperative evaluation group versus 7 days in the no preoperative evaluation group (p = 0.012). Logistic regression analysis identified as independent risk factors for the development of esophageal related complications included time delays in preoperative evaluation (odds ratio, 3.13), American Association for the Surgery of Trauma Organ Injury Scale grade >2 (odds ratio, 2.62), and resection and diversion (odds ratio, 4.47). CONCLUSION: Esophageal injuries carry a high morbidity and mortality. Increased esophageal related morbidity occurs with the diagnostic workup and its inherent delay in operative repair of these injuries. For centers practicing selective management of penetrating neck injuries and transmediastinal gunshot wounds, rapid diagnosis and definitive repair should be made a high priority.

Adolescent↗
PubMed1997

Risk factors for 'whiplash' in drivers: a cohort study of rear-end traffic crashes.

'Whiplash' injuries are a common cause of road traffic accident (RTA) related morbidity. However, few epidemiological studies have investigated risk factors associated with the occurrence of such injuries. The purpose of this study was to examine relationships between vehicle and occupant factors and the incidence of 'whiplash' in drivers with recent experience of a rear-end impact in an RTA. A cohort of 246 car drivers with recent experience of a rear-end impact in the Adelaide metropolitan area was recruited. Structured telephone interviews were used to obtain information about driver demographics, the circumstances of the crash, and injuries resulting from the crash. Two factors were identified as independent risk factors for 'whiplash' injury: a history of neck injury (adjusted odds ratio = 4.50, 95 per cent confidence interval 1.97-10.28) and female sex (adjusted odds ratio = 2.08, 95 per cent confidence interval 1.13-3.82). The relative weight of the striking vehicle to the driver's vehicle was also positively associated with risk of 'whiplash' injury. There was no evidence that the driver's occupation or level of education are predictors of occurrence. Methodological aspects of the study which might have resulted in bias are discussed and suggestions are given for overcoming these in future work.

Accidents, Traffic↗
PubMed2007

Children injured following TV tipovers in Israel, 1997-2003.

BACKGROUND: According to the US Consumer Product Safety Commission, about 7000 children, many under age five, are treated annually at emergency rooms for injuries associated with unintentional tipping of television (TV) and furniture. However, the professional literature does not reflect much inquiry regarding this source of risk. In Israel, cases of children injured following TV tipover are reported in newspapers but no studies were conducted in Israel on this issue. The aim of this report is to present data regarding frequency and characteristics of children injured following a falling TV in Israel during recent years, in order to provide more specific information for advising policymakers and raising awareness about this growing danger. METHODS: Data were obtained from the Israeli National Trauma Registry, and included injured children (0-17) hospitalized between 1997 and 2003, because of TV-related injury. Demographic information, Injury Severity Score (ISS), injured body region, surgical intervention, admission to the intensive care unit, length of hospital stay, destination at discharge and mortality were analysed. RESULTS: There were 116 children injured following TV tipover during the years analysed, increasing from nine in 1997 to 27 in 2003. Over half of the children (54.3%) were aged 1-2 years; 57.8% were boys. Three-quarters of the TV-related injuries were head and neck injuries; nearly one-fifth had ISS scores of over 15. The mean was 4.3 (median = 2 days); 15 children (12.9%) required surgery and four children died in the hospital. CONCLUSION: The findings reflect the fact that TV tipover is a growing source of danger that can be serious and should be brought to the attention of the public, health professionals and policymakers. Specific, age-related recommendations should be proposed, such as placing TVs on low and stable surface and not placing the remote controls on the top of the set.

Accidents, Home↗
PubMed1989

Anthropomorphic dummy neck modeling and injury considerations.

This study investigates the modeling of the Hybrid III dummy head and neck system and its response under impulsive loading. Two neck models were proposed, one rigid, one flexible; both give satisfactory head kinematics upon comparing to minisled test results. The flexible neck model provides a more detailed understanding of the Hybrid III neck structure behavior. It indicates that the Hybrid III neck has a torque response similar to a human neck but has higher shear response. During flexion whiplash, the torque at the occipital condyle reverses its direction at about 25 ms after impact. Since concussion may be related to the head angular acceleration, which reaches its peak value in the first 25 ms, it might be necessary to extend the existing human torque-rotation corridor to include the neck response in this region. For flexion whiplash impact, simulation results indicated that the neck injury threshold is reached before exceeding the head injury threshold as the impact velocity is increased.

Acceleration↗
PubMed1997

Head, neck, and facial injuries in ice hockey: the effect of protective equipment.

OBJECTIVES: To determine the factors and behaviors associated with facial, head, and/or neck injuries to those engaged in ice hockey; the use of protective equipment was also examined. DESIGN: Prospective case series. SETTING: Emergency Department of Sudbury General Hospital. PATIENTS: All patients presenting to the emergency department with a head, neck, or facial injury while playing hockey between the months of October and March 1993-94 and 1994-95 were included in the study. Physicians completed data forms on each patient. Information was validated by review of the emergency-room records; further information was obtained by telephone. RESULTS: A total of 226 patients were identified with ice-hockey-related head, neck, or facial injuries. Most injuries involved males (99%), and the mean age of patients was 23.9 (range, 4-63). Injuries occurred most frequently to the face [192 (85%)]. Many of the injuries were minor, with a mean injury severity score of 1.5 (range, 1-25). However, three patients (1%) required hospital admission, and one teenager suffered a serious spinal fracture. Protective facial hockey equipment use was low in our sample, except among younger injured players. Most of the facial injuries occurred in mature athletes playing recreational hockey. Full facial protection reduced the chance of upper facial injury (p = 0.0001), but the risk of such injury while wearing a half-visor was the same as while wearing no facial protection at all (p > 0.05). From the current study, we estimate that these hockey injuries result in approximately 2.7-3.0 million dollars of direct acute-care medical expenditure per year in emergency departments throughout Ontario. CONCLUSIONS: Head, neck, and facial injuries suffered during ice hockey participation are common problems presented to emergency departments. Moreover, serious injuries can occur while playing this sport. Most injuries appear to be preventable, and facial protection appears to be less frequently used, especially by older men, than is currently recommended. Prevention strategies are discussed.

Adolescent↗
PubMed2002

Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders.

PURPOSE: To evaluate whether helmets increase the incidence and/or severity of cervical spine injury; decrease the incidence of head injury; and/or increase the incidence of collisions (as a reflection of adverse effects on peripheral vision and/or auditory acuity) among young skiers and snowboarders. METHODS: During one ski season (1998-99) at a world class ski resort, all young skiers and snowboarders (<13 years of age) presenting with head, face, or neck injury to the one central medical facility at the base of the mountain were identified. On presentation to the clinic, subjects or their parents completed a questionnaire reviewing their use of helmets and circumstances surrounding the injury event. Physicians documented the site and severity of injury, investigations, and disposition of each patient. Concurrently, counts were made at the entry to the ski area of the number of skiers and snowboarders wearing helmets. RESULTS: Seventy children were evaluated at the clinic following ski/snowboard related head, neck, and face injuries. Fourteen did not require investigation or treatment. Of the remaining 56, 17 (30%) were wearing helmets and 39 (70%) were not. No serious neck injury occurred in either group. Using helmet-use data from the hill, among those under 13 years of age, failure to wear a helmet increased the risk of head, neck, or face injury (relative risk (RR) 2.24, 95% confidence interval (CI) 1.23 to 4.12). When corrected for activity, RR was 1.77 and 95% CI 0.98 to 3.19. There was no significant difference in the odds ratio for collisions. The two groups may have been different in terms of various relevant characteristics not evaluated. No separate analysis of catastrophic injuries was possible. CONCLUSION: This study suggests that, in skiers and snowboarders under 13 years of age, helmet use does not increase the incidence of cervical spine injury and does reduce the incidence of head injury requiring investigation and/or treatment.

Adolescent↗