Influence of Skull Fracture on Traumatic Brain Injury Risk Induced by Blunt Impact

Ren, Lihai; Wang, Dangdang; Liu, Xi; Yu, Hongbin; Jiang, Chengyue; Hu, Yuling

doi:10.3390/ijerph17072392

Cited by 26 publications

(12 citation statements)

References 32 publications

(52 reference statements)

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“…Our results could provide practical information for physicians, but the process of deciding to withhold life-sustaining support is still complicated because it involves ethical matters. However, although seemingly paradoxical, the results of these basic studies on mechanics [17][18][19] might explain the results of our clinical observational study, namely that calvarial fractures are associated with avoiding tracheostomy.…”

Section: Discussionmentioning

confidence: 61%

“…Ren et al reported that a skull fracture could significantly reduce the risk of brain injury under medium and high velocities. 18 Moreover, Ruan et al reported that the brain's iso-stress curve was higher than that of the skull, indicating that a skull fracture can occur more easily than concussion. 19 A space-occupied lesion, its volumetric effect, and evacuation could affect the severity of neurotic damage.…”

Section: Discussionmentioning

confidence: 99%

“…Ren et al . reported that a skull fracture could significantly reduce the risk of brain injury under medium and high velocities 18 …”

Section: Discussionmentioning

confidence: 99%

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Absence of calvarial fracture could predict the need for tracheostomy in traumatic brain injury

Murasaki

Tanizaki

Nakanishi

et al. 2021

Acute Medicine & Surgery

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Aim: Tracheostomy is a common procedure for intubated patients with traumatic brain injury (TBI) in the intensive care unit (ICU) but optimal timing and the predictors of tracheostomy are still unclear. The aim of our study was to explore whether the traumatic variables of head injury predict the need for tracheostomy in intubated TBI patients.Methods: A single-center, retrospective observational study including a series of TBI patients admitted to Fukui Prefectural Hospital from April 1, 2004 to March 31, 2020 was carried out. Our primary outcome was tracheostomy. Patients with TBI who were intubated and admitted into the ICU within 24 h after injury were enrolled. Exclusion criteria were age less than 18 years, pregnancy, mortality within 24 h, post-cardiac arrest syndrome, and patients for whom life-sustaining interventions were withheld. Radiologic images were also reviewed and the morphology of the head injury was categorized.Results: Seventy-six patients were included. Forty-six patients (60.5%) underwent tracheostomy and 30 patients (39.5%) were successfully extubated. Calvarial fracture (odds ratio [OR] 0.34; 95% confidence interval [CI], 0.13-0.88; P = 0.03), Injury Severity Score (OR 1.07; 95% CI, 1.00-1.15; P = 0.04), and Glasgow Comas Scale score (OR 0.84; 95% CI, 0.73-0.96) were statistically significant in the univariable analysis. Multivariate logistic regression identified calvarial fracture as an independent predictor for tracheostomy. The model involving calvarial fracture, Injury Severity Score ≥16, and Glasgow Coma Scale score ≤8 showed the area under the receiver operating characteristic curve for the model was 0.737 (95% CI, 0.629-0.846). Conclusions:The absence of calvarial fracture could predict the necessity for tracheostomy in intubated TBI patients when combined with other factors. Further prospective randomized trials are necessary to confirm the findings.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Absence of calvarial fracture could predict the need for tracheostomy in traumatic brain injury

Murasaki

Tanizaki

Nakanishi

et al. 2021

Acute Medicine & Surgery

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“…The clinical importance of skull fractures has been reported in the literature; however, the prognostic value of skull fractures remains unclear. Simulation data showed that skull fractures could reduce the risk of diffuse brain injury, but increase the risk of brain contusion [ 3 ]. Skull fractures have been reported to contribute to unfavorable outcomes in moderate [ 4 ] or severe TBI [ 5 ] and increase the risk of leakage of cerebrospinal fluid [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The Association between Skull Bone Fractures and the Mortality Outcomes of Patients with Traumatic Brain Injury

Tsai

Rau

Huang

et al. 2022

Emergency Medicine International

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Introduction. Skull fractures are often found in patients with traumatic brain injury (TBI). Although skull fractures may indicate greater force impact and are associated with local or diffuse brain injuries, the prognostic value of skull fractures remains unclear. This retrospective study aimed to assess the association between skull fractures and mortality in patients with TBI. Methods. This study included 5,430 TBI patients registered in the trauma registry system from January 2009 to December 2018. Clinical and demographic data including age, sex, trauma mechanisms, comorbidities, Glasgow Coma Scale (GCS) score, abbreviated injury score (AIS)-head, injury severity score (ISS), and in-hospital mortality were acquired. Multiple logistic regression and propensity score matching were used to elucidate the effect of skull fractures on mortality outcomes of TBI patients. Results. Compared to TBI patients without skull fracture, patients with skull fractures were predominantly male, younger, had lower GCS upon arrival at the emergency room, and had higher AIS-head, ISS, and in-hospital mortality. The patients with skull fracture had 1.7-fold adjusted odds of mortality (95% confidence interval (CI): 1.27–2.25; p < 0.001 ) than those without skull fracture, controlling for age, sex, comorbidities, and AIS-head. Additionally, the propensity score-matched analysis of 1,023 selected paired patients revealed that skull fracture was significantly associated with increased 1.4-fold odds of risk for mortality (95% CI: 1.02–1.88; p = 0.036 ). Conclusions. Using a propensity score-matched cohort to attenuate the confounding effect of age, comorbidities, and injury severity, skull fracture was identified as a significant independent risk factor for mortality in patients with TBI.

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“…Although consisting of a numerical procedure to determine approximate solutions for physical or mathematical problems, it requires a precise representation of complex geometries, boundary conditions, and suitable constitutive laws. These models have been used in several fields, from the study of sports trauma to traffic accident reconstruction and forensic research [ 15 , 16 , 17 , 18 , 19 ]. FE models of the skull have also been used in the study of cranioplasty implant systems for the human skull [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Computational Modeling of Skull Bone Structures and Simulation of Skull Fractures Using the YEAHM Head Model

Barbosa

Fernandes

Sousa

et al. 2020

Biology

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The human head is a complex multi-layered structure of hard and soft tissues, governed by complex materials laws and interactions. Computational models of the human head have been developed over the years, reaching high levels of detail, complexity, and precision. However, most of the attention has been devoted to the brain and other intracranial structures. The skull, despite playing a major role in direct head impacts, is often overlooked and simplified. In this work, a new skull model is developed for the authors’ head model, the YEAHM, based on the original outer geometry, but segmenting it with sutures, diploë, and cortical bone, having variable thickness across different head sections and based on medical craniometric data. These structures are modeled with constitutive models that consider the non-linear behavior of skull bones and also the nature of their failure. Several validations are performed, comparing the simulation results with experimental results available in the literature at several levels: (i) local material validation; (ii) blunt trauma from direct impact against stationary skull; (iii) three impacts at different velocities simulating falls; (iv) blunt ballistic temporoparietal head impacts. Accelerations, impact forces, and fracture patterns are used to validate the skull model.

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Influence of Skull Fracture on Traumatic Brain Injury Risk Induced by Blunt Impact

Cited by 26 publications

References 32 publications

Absence of calvarial fracture could predict the need for tracheostomy in traumatic brain injury

Absence of calvarial fracture could predict the need for tracheostomy in traumatic brain injury

The Association between Skull Bone Fractures and the Mortality Outcomes of Patients with Traumatic Brain Injury

Computational Modeling of Skull Bone Structures and Simulation of Skull Fractures Using the YEAHM Head Model

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