Objective To identify relationships between skull fracture (SF) and hyperfibrinolysis (HF) among patients with isolated traumatic brain injury (TBI). Methods This was a retrospective cohort study based on a nationwide neurotrauma database in Japan. Adult patients with isolated TBI (head Abbreviated Injury Scale [AIS] >2, any other AIS <3) and who were registered in the multicenter neurotrauma registry from 2015 to 2017 were included. To examine the relationship between SF and HF, we conducted multivariable logistic regression analyses to calculate the adjusted odds ratios (aORs) with their 95% confidence intervals (CIs) for HF. HF was defined as a D-dimer level ≥38 mg/L on arrival based on a previous study. Results A total of 335 patients were enrolled and the median age of the cohort was 64 years (interquartile range, 44–76 years). HF was observed in 161 patients (48.1%). The association of SF with HF yielded an aOR of 4.78 (95% CI, 2.71–8.42) compared to non-SF in multivariable logistic regression analysis. In addition, the associations of skull base fracture, skull vault fracture, and combination of skull base and vault fracture with HF yielded the corresponding aORs of 3.60 (95% CI, 1.20–10.81), 4.99 (95% CI, 2.63–9.44), and 4.84 (95% CI, 2.41–9.72), respectively, relative to non-SF. Conclusion This multicenter observational study demonstrated the association of SF with HF in patients with isolated TBI.
Objective Most patients with head trauma require brain computed tomography (CT) in the emergency department. However, the requirement for facial CT remains controversial. The aim of this study was to evaluate the diagnostic value of brain CT alone for detection of facial fractures and its ability to determine the requirement for additional facial CT.
Methods This retrospective multicenter study was conducted in two tertiary hospitals in Seoul, Republic of Korea, between January 2014 and December 2015. Data were collected from the medical records of adult patients (aged over 18 years) who had undergone both brain and facial CT on the same day as their presentation to the emergency department with blunt trauma to the head and face. The same radiologist analyzed all brain and facial CT images.
Results Eight hundred and sixty patients (668 men, 192 women; mean age 48.60±18.2 years) were identified to have had facial fractures. There was a statistically significant predominance of men but not of any particular age group. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of brain CT were 83.72%, 98.87%, 97.17%, 92.92%, and 94.08%, respectively.
Conclusion These findings suggest that brain CT has high diagnostic value for detection of upper facial bone fractures with high accuracy and can aid emergency physicians when determining the requirement for additional facial CT.
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OBJECTIVE The clavicle is almost always involved in skull X-rays of infants. The objectives of this study were to determine how often the clavicle and clavicle fractures are visible but missed on skull anterior-posterior view (skull AP) of infants and which factors are associated with missing the diagnosis.
MATERIALS AND METHODS: We retrospectively studied about the patients aged 1 year or younger who were taken skull AP for any injury survey at a single urban, academic hospital from April 1999 to July 2012. Outcomes of interest were the numbers and percentage of visible clavicles, clavicle fractures including missed ones on skull AP, and the factors associated with a missing the diagnosis.
RESULTS Both clavicles were visible in 734 patients (89.6%). Of them, 10 cases (1.4%) of clavicle fractures were confirmed and 6 of them (0.8%) were missed at presentation. Although we tried to determine the factors associated to missed diagnoses among age (< 6 months), male sex, blocking by guardian’s hands, associated skull fractures, mechanism of injury, none was significantly associated with clavicle fractures.
CONCLUSION The clavicle was recognizable on skull X-rays in most cases. Therefore one should check the clavicle while reading skull X-rays.
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