What do under 15 year old schoolboy rugby union players think about protective headgear?
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OBJECTIVES: When protective headgear is designed, the attitudes of the intended users needs to be taken into account, as well as safety performance criteria. The aim of this study was therefore to determine the attitudes of schoolboy rugby union players towards protective headgear. METHODS: A survey of 140 rugby union players (82.4% response rate) from 10 randomly selected school teams in metropolitan Sydney was conducted at the end of the 1999 playing season. All players were aged 14-16 years. All teams had participated in a trial of headgear during the 1999 season in which six of the teams had been assigned to a headgear trial arm and four teams to a control arm. Players completed a self report questionnaire during a supervised session at school. The questionnaire collected information on recent head injuries, use of protective equipment, and attitudes towards headgear. RESULTS: Some form of protective equipment was always worn by 76.1% of players: 93.6% reported using a mouthguard and 79.3% a helmet/headgear during the 1999 season. The two most important reasons for wearing headgear were related to safety concerns. Players with no recent head/neck injury were more likely to report that they felt safer when wearing headgear (p<0.001) and less likely to cite a previous injury as a motivating factor for wearing headgear (p<0.001) than those who had sustained a recent head/neck injury. Of the players who wore headgear during the 1999 season, 67% said that they played more confidently when they wore headgear, but 63% said that their head was hotter. Few players reported that their head was uncomfortable (15%) or that it was hard to communicate (3%) when they wore headgear. The main reasons for not wearing headgear were related to its design features: uncomfortable (61%) and it was hot (57%). CONCLUSIONS: The primary reason cited by players for wearing headgear is safety. Receiving an injury would also motivate non-wearers to wear headgear. Players report that they are more confident and able to tackle harder if they wear headgear, suggesting that a belief in its protective capabilities may influence behaviour. These attitudes need to be addressed in the design of effective headgear as well as in strategies to promote its use. (+info)
Plasma vitamin C levels are decreased and correlated with brain damage in patients with intracranial hemorrhage or head trauma.
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BACKGROUND AND PURPOSE: Free radical hyperproduction may play an important role in brain hemorrhage and ischemia/reperfusion injury. The aims of this study were to assess whether antioxidant depletion occurs after intracranial hemorrhage (ICH) and head trauma (HT) and to evaluate the relation between the diameter of the brain lesion, the degree of the neurological impairment, and any observed antioxidant changes. METHODS: We measured plasma levels of vitamin C (ascorbic acid, AA), uric acid (UA), vitamin E (alpha-tocopherol), and ubiquinol-10 in 13 patients with ICH and 15 patients with HT on the day of the brain injury and subsequently every other day up to 1 week. Patients were compared with 40 healthy control subjects. RESULTS: ICH and HT patients had significantly lower plasma levels of AA compared with healthy subjects, in contrast to plasma levels of UA, alpha-tocopherol, and ubiquinol-10. AA levels were significantly inversely correlated with the severity of the neurological impairment as assessed by the Glasgow Coma Scale and the National Institutes of Health Stroke Scale. AA levels were also significantly inversely correlated with the major diameter of the lesion. In addition, mean plasma AA levels were lower in jugular compared with peripheral blood samples obtained from 5 patients. CONCLUSIONS: These findings suggest that a condition of oxidative stress occurs in patients with head trauma and hemorrhagic stroke of recent onset. The consequences of early vitamin C depletion on brain injury as well as the effects of vitamin C supplementation in ICH and HT patients remain to be addressed in further studies. (+info)
Contre-coup extradural haematoma : a short report.
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An extradural haematoma contralateral to impact site is reported. Review of literature reveals that such phenomenon is extremely rare. (+info)
First rib fracture: a hallmark of severe trauma.
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First rib fractures occurred in 55 patients. This injury is a harbinger of major trauma with 35 patients suffering a major chest injury, and abdominal and cardiac injuries occurring in 18 and eight patients respectively. The mortality associated with this injury was high (36.3%). Neurologic lesions accounted for the majority of deaths, however, unrecognized abdominal injuries and pulmonary complications were significant causes of mortality. Brachial plexus injury (5) and Horner's syndrome (3) occurred in survivors. Three patients had an associated injury of the subclavian artery, and the importance of this association is stressed. One late-developing post-traumatic thoracic outlet syndrome occurred. A fracture of the first rib is a hallmark of severe trauma; its presence should alert the clinician to: 1) generalized massive trauma with abdominal, chest, and cardiac injuries; 2) local injury to the subclavian artery and brachial plexus and; 3) necessity of long-term followup for late-developing sequelae. (+info)
The changing pattern of post-traumatic respiratory distress syndrome.
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During a one year period, 78 patients at the Denver General Hospital required mechanical ventilation following injury. Thirteen patients were judged to have Respiratory Distress Syndrome. Of these, 9 had classic early onset RDS but, with intravenous fluid restriction following resuscitation, diuretics and careful mechanical ventilation, all recovered. Six patients, all of whom were septic, developed late onset RDS 5 or more days after injury; 5 died. Disparity between early and late onset of RDS is emphasized; the one with good, the other with dismal prognosis. The current need is to improve treatment of late onset RDS, which frequently is associated with bacterial infection. (+info)
Microcephaly following baby battering and shaking.
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Three cases of microcephaly following the rough handling of babies are described. If detailed social and psychiatric information had not been available, these three children would have become part of the large proportion of individuals in subnormality hospitals who have unsatisfactory and incomplete diagnoses. (+info)
Neuropathology of inflicted head injury in children. I. Patterns of brain damage.
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Fifty-three cases of non-accidental head injury in children were subjected to detailed neuropathological study, which included immunocytochemistry for microscopic damage. Clinical details were available for all the cases. There were 37 infants, age at head injury ranging from 20 days to 9 months, and 16 children (range 13 months to 8 years). The most common injuries were skull fractures (36% of cases), acute subdural bleeding (72%) and retinal haemorrhages (71%); the most usual cause of death was raised intracranial pressure secondary to brain swelling (82%). On microscopy, severe hypoxic brain damage was present in 77% of cases. While vascular axonal damage was found in 21 out of 53 cases, diffuse traumatic axonal injury was present in only three. Eleven additional cases, all of them infants, showed evidence of localized axonal injury to the craniocervical junction or the cervical cord. When the data were analysed by median age at head injury, statistically significant patterns of age-related damage emerged. Our study shows that infants of 2-3 months typically present with a history of apnoea or other breathing abnormalities, show axonal damage at the craniocervical junction, and tend also to have a skull fracture, a thin film of subdural haemorrhage, but lack extracranial injury. Children over 1 year are more likely to suffer severe extracranial, particularly abdominal, injuries. They tend to have larger subdural haemorrhages, and where traumatic axonal injury is present, show patterns of hemispheric white matter damage more akin to those reported in adults. Diffuse axonal injury is an uncommon sequel of inflicted head injury in children. (+info)
Neuropathology of inflicted head injury in children. II. Microscopic brain injury in infants.
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There are very few reports in the literature dealing with the neuropathology of infant head injury, and the question of whether diffuse traumatic brain damage [diffuse axonal injury (DAI)] occurs in such children has not yet been reliably established by detailed neuropathological studies. We report the findings in the brains of a series of 37 infants aged 9 months or less, all of whom died from inflicted head injuries, and 14 control infants who died of other causes. Axonal damage was identified using immunohistochemistry for beta-amyloid precursor protein. Full clinical details were available for each case, the most constant of which in the study cohort was an episode of significant apnoea at presentation, found to have been recorded in 75% of cases. Global hypoxic damage was the most common histological finding. Widespread axonal damage, interpreted as vascular, was present in 13 cases, but widespread traumatic axonal injury was found in only two children, both of whom had severe head injuries with multiple skull fractures. Epidural cervical haemorrhage and focal axonal damage to the brainstem and the spinal nerve roots, found in 11 cases but not in controls, indicate that the craniocervical junction is vulnerable in infant head injury, the neuropathology being that of stretch injury from cervical hyperextension/flexion. Damage to this region could account for the observed apnoea, which could in turn lead to hypoxic damage and brain swelling. The observation that the predominant histological abnormality in cases of inflicted head injury in the very young is diffuse hypoxic brain damage, not DAI, can be explained in one of two ways: either the unmyelinated axon of the immature cerebral hemispheres is relatively resistant to traumatic damage, or in shaking-type injuries the brain is not exposed to the forces necessary to produce DAI. (+info)