Pediatric crushing head injury: biomechanics and clinical features of an uncommon type of craniocerebral trauma.
ABSTRACT BACKGROUND: Head injuries constitute one of the leading causes of pediatric morbidity and mortality. Most injuries result from accidents involving an acceleration/deceleration mechanism. However, a special type of head injury occurs when the children sustain a traumatism whose main component is a static load in relation to a crushing mechanism with the head relatively immobile. PATIENTS AND METHODS: We report a series of children who sustained a craniocerebral injury of variable severity produced by head crushing. We also analyze epidemiological and clinical data, and biomechanics in these injuries. RESULTS: Mean age of the group (13 boys/6 girls) was 4.1 years. All patients showed external lesions (scalp wounds or hemorrhage from the nose, ears, or throat). Eleven children were initially unconscious. Six children presented cranial nerve deficits in addition to impaired hearing. Skull base fractures were seen in most cases with extension to the vault in 11 instances. Fourteen patients had an associated intracranial lesion, including two with diffuse axonal injury. Surgery was performed in three instances. Only seven patients were left with sequelae. DISCUSSION AND CONCLUSIONS: The observed skull, brain, and cranial nerve lesions corresponded to a mechanism of bilateral compression of the children's heads mainly occasioned by a static load, although an associated component of dynamic forces was also involved. The skull and its covering and the cranial nerves were the most severely affected structures while the brain seemed to be relatively well preserved. Most crush injuries appear to be preventable by the appropriate supervision of the children.
- SourceAvailable from: Ernest E Moore[show abstract] [hide abstract]
ABSTRACT: The aim of this study was to investigate driveway-related injuries in children, identify associated risk factors, and evaluate outcome compared with other mechanisms of blunt trauma. A 6-year review (1991 to 1996) of pediatric (age less than 18 years) pedestrian injuries treated at two urban trauma centers was conducted: one regional pediatric trauma center and one level I trauma center with pediatric commitment. Five hundred twenty-seven children injured in pedestrian accidents were identified from the trauma registry; 51 children (10%) sustained traumatic injuries as a result of being struck in their driveway. Data are reported as mean +/- SEM. Children less than 5 years of age (n = 41) had an injury severity score (ISS) of 12.3+/-2.3, 15 (37%) sustained closed head injury, 13 (37%) had torso trauma, 19 (46%) skeletal trauma, and eight (20%) died. Children > or = 5 years old (n = 10) had an ISS of 10.7+/-2.4, three (30%) sustained closed head injury, four (40%) torso trauma, six (60%) skeletal trauma, and none died. In contrast, all other pediatric pedestrian accidents analyzed over the same time period had a mortality rate of only 2% (11 of 476). Pediatric driveway trauma carries a significant risk of head injury and a 10-fold increase in mortality in children under 5 years of age when compared with all other pediatric pedestrian accidents. More emphasis must be placed on injury prevention and public education to prevent this devastating mechanism of injury in these young, vulnerable children.Journal of Pediatric Surgery 12/1998; 33(11):1712-5. · 1.38 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: To describe the epidemiology of pediatric injuries associated with furniture tip-overs in the United States. Data from the National Electronic Injury Surveillance System were analyzed for patients < or =17 years treated in emergency departments for a furniture tip-over-related injury from 1990 through 2007. An estimated 264 200 furniture tip-over-related injuries occurred during the study period, yielding an average of 14 700 injuries annually, or 20.7 per 100 000 population per year. There was a significant increase in the number and rate of these injuries during the 18-year period. Three-quarters of injuries were to children < or =6 years. Televisions were the item most commonly involved (47.4%). Head/neck injuries were the most common (42.2%) injury type among children 0 to 9 years of age. The number and rate of injuries to children associated with furniture tip-overs are increasing. Pediatricians and caregivers should be aware of this important source of pediatric injury and the strategies for prevention.Clinical Pediatrics 05/2009; 48(8):851-8. · 1.27 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: The United States Consumer Product Safety Commission (USCPSC) recently has reported a significant number of injuries and deaths in the home related to televisions (TV) falling on children. To date, little is known regarding the significance of this mechanism of injury in childhood trauma. The current investigation was designed to examine the risk factors, spectrum of injuries, and operative intervention required in children injured by falling televisions. The records of all patients 0 to 16 years of age with television-related injuries and entered in the Pennsylvania Trauma Outcome Study (PTOS) between 1989 and 1999 were reviewed. The authors examined Glascow coma scale (GCS), injury severity score (ISS), length of hospital stay (LOS), major injuries sustained, and operative procedures performed. Fourteen of the children in the PTOS were seen at the Benedum Pediatric Trauma Center at the Children's Hospital of Pittsburgh. In these 14 children, a review of the medical records was performed for a detailed description of the accident scenario. Forty-three children sustained television-related injuries during this period. Nearly 56% of these children were </= years; 60% were boys. The mortality rate was 11% with 80% of the deaths occurring in children </= years. Furthermore, these children sustained the highest ISS and LOS and lowest GCS. The majority of injuries sustained were head injuries followed by extremity fractures. Dressers and standard television stands were common supportive structures from which the television fell and injured the child. These data show that the majority of television-related injuries occur in toddlers (1 to 3 years) who were left unattended at home. The mortality rate was surprisingly high, especially in children </= years from subsequent head injuries. Prevention focused on improved public awareness of this danger, and modified design of the standard support structures can decrease the number of injuries, which will benefit children overall.Journal of Pediatric Surgery 05/2002; 37(4):572-5. · 1.38 Impact Factor