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Increased incidence of nonaccidental head trauma in infants associated with the economic recession

Clinical article

Mary I. Huang, Mary Ann O'Riordan, Ellen Fitzenrider, Lolita McDavid, Alan R. Cohen, and Shenandoah Robinson

N onaccidental head trauma (NAHT) is the major cause of death in abused children. 2 , 3 Diagnostically, NAHT is commonly associated with subdural hematoma and retinal hemorrhages in infants. Because NAHT has a diverse presentation, it is important for physicians to have a keen clinical suspicion so that an appropriate thorough screening workup can be initiated. 1 , 3 , 8 , 10 In a recent report on NAHT, 66% of families lived in the inner city and 76% received public assistance; however, all population segments are at risk. 1 Economic recession is

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Prevalence of cervical spinal injury in trauma

Andrew H. Milby, Casey H. Halpern, Wensheng Guo, and Sherman C. Stein

Q uadriplegia due to spinal cord injury is a devastating consequence of trauma to the cervical spine, involving numerous functional, psychosocial, and economic ramifications. 7 , 12 , 13 , 24 , 25 , 27–29 , 45 , 49 , 61 Identification of unstable CSI is therefore an essential aspect of the trauma evaluation in preventing subsequent neurological damage. 6 , 22 , 71 , 72 , 75 , 76 This task is especially difficult in patients who are not clinically evaluable (unevaluable group) because of intoxication or concomitant head injury, and has led to the use of

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Pituitary failure secondary to head trauma

Case report

William W. Winternitz and James A. Dzur

trauma should have plasma cortisol determinations daily for the first 2 or 3 days. Patients with basal fractures or diabetes insipidus should be followed especially carefully. 2) Patients receiving steroid therapy (dexamethazone) should have cortisols followed when therapy is discontinued. 3) Patients exhibiting poor recovery, posttraumatic psychoses, or general malaise and failure to thrive should have screening tests to insure that their hypothalamic pituitary axis is intact. References 1. Altman R , Pruzanski W : Post

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Contemporary management of pediatric open skull fractures: a multicenter pediatric trauma center study

Cory McFall, Alexandra D. Beier, Kelsey Hayward, Emily C. Alberto, Randall S. Burd, Bethany J. Farr, David P. Mooney, Kristin Gee, Jeffrey S. Upperman, Mauricio A. Escobar Jr., Nicole G. Coufal, Helen A. Harvey, and Gerald Gollin

exposure to nasopharyngeal flora must be considered. Open skull fractures represent a wide spectrum of injury ranging from linear, nondepressed fractures with an adjacent puncture wound of the scalp to large, depressed lesions with overlying soft-tissue loss or significant bacterial contamination. Recognizing that these diverse injuries must be cared for on a case-by-case basis, we sought to evaluate the management of a large population of patients with open calvarial skull fractures managed at multiple pediatric trauma centers to define contemporary care for these

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Pediatric cerebral venous sinus thrombosis or compression in the setting of skull fractures from blunt head trauma

David S. Hersh, Nir Shimony, Mari L. Groves, Gerald F. Tuite, George I. Jallo, Ann Liu, Tomas Garzon-Muvdi, Thierry A. G. M. Huisman, Ryan J. Felling, Joseph A. Kufera, and Edward S. Ahn

C erebral venous sinus thrombosis (CVST) is rare among the pediatric population and occurs at an incidence of 0.67 per 100,000 children per year. 1 , 42 , 50 , 60 A variety of predisposing factors contribute to the risk of sinus thrombosis, including infection, 26 , 28 cancer, 33 dehydration, 4 and prothrombotic disorders, 27 , 37 but trauma remains an underrecognized cause of CVST. 3 , 12 , 22 , 42 , 50 Although CVST is found in 4% of patients with penetrating trauma, 39 , 53 the relationship between blunt head trauma and sinus thrombosis is less clearly

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Cervical spine clearance after trauma in children

Richard C. E. Anderson, Eric R. Scaife, Stephen J. Fenton, Peter Kan, Kris W. Hansen, and Douglas L. Brockmeyer

C urrently , no national guidelines exist for clearance of the cervical spine in children after trauma. Even after a comprehensive scientific review was conducted and published in Neurosurgery as the “Management of Pediatric Cervical Spine and Spinal Cord Injuries” guidelines in 2002, 2 insufficient evidence was found to support diagnostic standards of care. Traditionally, clearance of the cervical spine after trauma has been performed by specialists in multiple disciplines including emergency department physicians, orthopedic surgeons, trauma surgeons

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Occipital aneurysmal bone cyst rupture following head trauma: case report

Sarah T. Garber and Jay K. Riva-Cambrin

lesions. 13 To our knowledge, a ruptured ABC as a result of head trauma has not been reported in the pediatric literature, and only one case report in the adult literature describes a similar phenomenon. 1 We present the case of a 3-year-old girl who had a previously undiagnosed ABC at the foramen magnum that ruptured in the form of an acute compressive epidural hematoma (EDH) after head trauma. We review the presenting symptoms, imaging features, treatment, and natural history of these rare lesions. Case Report History and Presentation A previously healthy

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Secondary overtriage of pediatric neurosurgical trauma at a Level I pediatric trauma center

Charles E. Mackel, Brent C. Morel, Jesse L. Winer, Hannah G. Park, Megan Sweeney, Robert S. Heller, Leslie Rideout, Ron I. Riesenburger, and Steven W. Hwang

L evel I and II trauma centers receive patients by either direct transport or transfer to offer immediate access to centralized and comprehensive regional specialty trauma services. For designation, Level I and Level II trauma services require the same level of clinical care, with Level I trauma centers additionally required to meet admission volume requirements, maintain a surgically directed critical care service as well as a residency program, and perform trauma research. 1 Moderately to severely injured patients treated at Level I trauma centers either

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Clival fractures in a Level I trauma center

Alexander Winkler-Schwartz, José A. Correa, and Judith Marcoux

T he clivus is the deepest bone of the skull base and is rarely injured, with a fracture incidence reported between 0.21% and 0.56% among head traumas. 7 , 29 , 32 , 33 Because of its rare presentation, much of the literature on clival fractures (CFs) is in the form of case reports, 1 , 3–5 , 8 , 9 , 11 , 12 , 14 , 15 , 17 , 19 , 21–26 , 28 , 34–37 , 39 , 41–45 , 47 , 48 with only 5 additional studies describing case series ranging from 9 to 41 cases. 7 , 20 , 29 , 32 , 33 Clival fractures carry a high mortality rate; between 24% and 31%. 29 , 33

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Anterior sacral pseudomeningocele following minimal trauma

Case report

Michael J. Cools, Wajd N. Al-Holou, William R. Stetler Jr., Frank La Marca, and Juan M. Valdivia-Valdivia

S acral fractures are uncommon injuries usually caused by a significant trauma. 17 Most often these fractures occur below S-2, as both S-1 and S-2 are rigidly fixed to the pelvis. 12 Neurological injury occurs in 15%–25% of cases, with the majority of neurological injuries being radiculopathies. 8 , 16 , 21 Cauda equina syndrome also occurs, but is much rarer. 2 , 7 , 8 , 16 , 21 Overall, traumatic fractures involving the lumbosacral spine can result in pseudomeningoceles; however, this is most commonly seen at L-4 and L-5 as a result of nerve root