Physical violence in children and adolescents: a retrospective study of injuries to the head and neck region

Aim: This study aimed to investigate the prevalence of physical violence and head and neck injuries among children and adolescents who suffered physical aggression, firearm aggression, and white gun aggression referred to the Legal Medical Department in a southern city in Brazil. Methods: This study was performed at Legal Medical Department in the city of Pelotas, RS, Brazil, from January 2011 to December of 2015. Data were collected from medical reports of children and adolescents (0-19 years old). Demographic information such as sex, age, and skin color was collected. Data were submitted to Chi-square test and multivariate Poisson regression analysis. Results: In this study, 2,716 physical examination reports were analyzed, with a total of 2,171 exams resulting from violence; lesions that had physical aggression as their etiology (1,951) had a higher prevalence. The analysis of the exams revealed that the majority were adolescents (90,05%), white (84.09%), and female (50.21%). The head and neck regions were affected in most cases of violence (57.90%). In the adjusted model, the occurrence of injuries in the head and neck region was higher in males (PR 1.16, CI 95% 1.08 - 1.25), among adolescents (PR 1.28, CI 95% 1.10 - 1.48) and in victims of physical aggression compared to victims of the firearm (2.81, CI 95% 1.79 - 4.40). Conclusion: The results revealed a high prevalence of head and face injuries in victims of violence and that there was a greater prevalence of physical violence among adolescents compared to children and males

Epidemiological Pattern of Traumatic Brain Injury in Brazil between 2008 and 2019

Introduction Traumatic brain injuries (TBIs) are a public health problem with high economic impact, as well as an important cause of death and sequela in polytrauma patients, affecting mainly young adults. Objective To analyze the temporal trend of TBI incidence in Brazil between 2008 and 2019, according to age group and gender. Methods An ecological study, based on secondary data from hospital admissions for TBI in all Brazilian states between 2008 and 2019. The numbers were collected using the hospital information systemof the Unified Health System in Brazil.We performed a descriptive analysis using the data obtained. Linear regression models were used to measure the incidence trend of TBI in the period adopted. Results The state of Piauí had the highest increase in the incidence of TBI in the country in the last 10 years (coefficient ß»63.43 e p»0.002). The main concern, though, is the increase in the incidence of TBI amongst children (0­4 years old) in the states of Ceará (ß»31.22 and p<0.001 for boys; ß»42.20 and p<0.001 for girls), Paraná (ß»37.26 and p»0.011 for boys; ß»25.90 and p»0.015 for girls), Pernambuco (ß»20.08 and p»0.016 for girls), Mato Grosso (ß»18.76 and p»0.005 for boys; ß»16.11 and p»0.035 for girls), and Distrito Federal (ß»48.87 and p»0.004 for girls; ß»48.28 and p»0.006 for boys). Conclusion The analysis of the results is able to point out improvements that can be made. Besides that, it is remarkably important to redirect public polices to preventive medicine sincemany of the TBI causes are avoidable through awareness and education of the population.

Surgical Treatment of Carotid-cavernous Fistula Performed through the Brazilian Unified Health System

Introduction The carotid-cavernous fistula (CCF) is an abnormal communication between the arterial carotid system and the cavernous sinus. In most cases, spontaneous fistulas are due to the rupture of intracavernous carotid artery aneurisms. Traumatic fistulas occur in 0.2% of head injuries, and 75% of all CCFs are caused by automobile accidents or penetrating traumas. Objective To identify the data regarding the number of annual procedures, hospital expenses, length of hospital stay, and the number of deaths of patients admitted by the Brazilian Unified Health System (SUS, in the Portuguese acronym), in the period between 2007 and 2017, using the surgical code of the surgical treatment for CCF. Methods The present was an ecological study whose data were obtained by consulting the database provided by the Department of Computer Sciences of the Brazilian Unified Health System (Datasus, in Portuguese). Results A total of 85 surgical procedures were performed for the treatment of CCFs from January 2007 to October 2017 through the Unified Health System (SUS, in Portuguese), and there was a reduction of 71.42% in this period. The annual incidence of patients undergoing this surgical treatment during the period observed remained low, with 1 case per 13,135,714 in 2007, and 1 case per 51,925,000 in 2017. Conclusion Despite the low annual incidence of the surgical treatment of CCFs performed by the SUS in Brazil in the period of 2007­2017, based on the data obtained on the average length of stay and expenditures in hospital services, it is necessary that we develop an adequate health planning.

Perfil epidemiológico do traumatismo cranioencefálico no Nordeste do Brasil / Epidemiological profile of traumatic brain injury in Northeastern Brazil

O traumatismo cranioencefálico (TCE) se apresenta na realidade brasileira como importante causa de incapacitações e óbitos, sendo de especial interesse da saúde pública, também, devido à alta demanda de recursos para o tratamento de suas vítimas. Nesse contexto, análises sistemáticas sobre o tema são de grande relevância para o direcionamento de políticas preventivas. O presente trabalho tem por objetivo analisar o perfil do TCE na região Nordeste do Brasil, através de estudo exploratório, descritivo, epidemiológico, de série temporal, de janeiro de 2009 a dezembro de 2019, com dados secundários do DATASUS - Ministério da Saúde do Brasil. Foi constatado um aumento no número de internações e óbitos no período, sendo a maioria das vítimas do sexo masculino, da raça parda, com idade entre 20 e 39 anos. Os custos com internações são elevados e se encontram em ascensão.

raumatic brain injury (TBI) appears in the Brazilian reality as an important cause of disabilities and deaths, being of special interest to public health, also, due to the high demand for resources for the treatment of its victims. Based on this, systematic analyzes on the topic are of great relevance for the direction of preventive policies. The present work aims to analyze the profile of the TBI in Northeastern Brazil, through an exploratory, descriptive, epidemiological, time series study, from January 2009 to December 2019, with secondary data from DATASUS - Ministry of Health of Brazil. There was an increase in the number of hospitalizations and deaths in the period, with the majority of male victims, of brown race, aged between 20 and 39 years. Hospitalization costs are high and on the rise.

Perfil epidemiológico de pacientes adultos com traumatismo cranioencefálico grave na rede SUS do Distrito Federal: um estudo retrospectivo / Epidemiological profile of adult patients with severe traumatic brain injury in the SUS network in the Federal District: a retrospective study

INTRODUÇÃO: O traumatismo cranioencefálico (TCE) é considerado uma epidemia silenciosa e um grande problema de saúde pública mundial. Dados epidemiológicos precisos podem ajudar na formulação de políticas públicas e em estratégias para reduzir a incidência do TCE. O objetivo deste estudo foi descrever a epidemiologia do TCE grave de pacientes admitidos na unidade de terapia intensiva (UTI). MÉTODOS: Trata-se de um estudo retrospectivo com coleta de dados em prontuário eletrônico na UTI de um hospital da rede SUS do Distrito Federal. Foram analisados o perfil epidemiológico e os principais desfechos clínicos e funcionais de pacientes com TCE internados entre janeiro e dezembro de 2015. Uma análise estatística descritiva foi conduzida e os dados foram expressos em médias, intervalo de confiança de 95% (IC95%) e taxas. RESULTADOS: 227 pacientes foram estudados com média de idade de 38 anos (IC95% 36 a 40), sendo 84% (191/227) do sexo masculino. O principal mecanismo de trauma foi o acidente motociclístico, 19% (43/227) seguido dos atropelamentos, 18% (40/227). O tempo médio de ventilação mecânica foi de 14 dias, (IC95% 12 a 15) e os tempos médios de internação na UTI e hospitalar foram de 16 dias, (IC95% 14 a 18) e 42 dias, (IC95% 36 a 47), respectivamente. Apenas 16% (36/227) dos pacientes conseguiu permanecer em ortostase na alta da UTI. A taxa de mortalidade na UTI foi de 25% (57/227). CONCLUSÃO: Os homens jovens são os mais acometidos por TCE grave sendo o principal mecanismo o acidente motociclístico. Estes pacientes apresentam internação hospitalar prolongada e altas taxas de mortalidade

INTRODUCTION: traumatic brain injury (TBI) has been considered a silent epidemic and a major worldwide public health problem. Accurate epidemiological data can assist in the formulation of public policies and strategies to reduce the incidence of TBI. The aim of this study was to describe the epidemiology of severe TBI in patients admitted to the intensive care unit (ICU). METHODS: this is a retrospective study with data collected from electronic medical records from the ICU of a SUS hospital in the Federal District. The epidemiological profile and the main clinical and functional outcomes of patients with TBI hospitalized between January and December 2015 were analyzed. A descriptive statistical analysis was conducted and data were expressed as averages, 95% confidence interval (95% CI) and rates. RESULTS: 227 patients were studied with a mean age of 38 (95% CI 36 to 40), 84% (191/227) being male. The main mechanism of trauma was motorcycle collision, 19% (43/227) followed by pedestrian collision, 18% (40/227). The mean time of mechanical ventilation was 14 days, (95% CI 12 to 15) and the average length of stay in the ICU and hospital was 16 days, (95% CI 14 to 18) and 42 days, (95% CI 36 to 47), respectively. Only 16% (36/227) of patients managed to remain in orthostasis upon discharge from the ICU. The mortality rate in the ICU was 25% (57/227). CONCLUSION: Young men are the most affected by severe TBI, and the main mechanism was motorcycle accidents. These patients have prolonged hospital stays and high mortality rates

Events associated with the occurrence of intracranial hypertension in pediatric patients with severe cranioencephalic trauma and monitoring of intracranial pressure / Eventos associados à ocorrência de hipertensão intracraniana em pacientes pediátricos com traumatismo cranioencefálico grave e monitoração da pressão intracraniana

ABSTRACT Objective: To determine the events associated with the occurrence of intracranial hypertension (ICH) in pediatric patients with severe cranioencephalic trauma. Methods: This was a prospective cohort study of patients 18 years old and younger with cranioencephalic trauma, scores below nine on the Glasgow Coma Scale, and intracranial pressure monitoring. They were admitted between September, 2005 and March, 2014 into a Pediatric Intensive Care Unit. ICH was defined as an episode of intracranial pressure above 20 mmHg for more than five minutes that needed treatment. Results: A total of 198 children and adolescents were included in the study, of which 70.2% were males and there was a median age of nine years old. ICH occurred in 135 (68.2%) patients and maximum intracranial pressure was 36.3 mmHg, with a median of 34 mmHg. A total of 133 (97.8%) patients with ICH received sedation and analgesia for treatment of the condition, 108 (79.4%) received neuromuscular blockers, 7 (5.2%) had cerebrospinal fluid drainage, 105 (77.2%) received mannitol, 96 (70.6%) received hyperventilation, 64 (47.1%) received 3% saline solution, 20 (14.7%) received barbiturates, and 43 (31.9%) underwent a decompressive craniectomy. The events associated with the occurrence of ICH were tomographic findings at the time of admission of diffuse or hemispheric swelling (edema plus engorgement). The odds ratio for ICH in patients with Marshall III (diffuse swelling) tomography was 14 (95%CI 2.8-113; p<0.003), and for those with Marshall IV (hemispherical swelling) was 24.9 (95%CI 2.4-676, p<0.018). Mortality was 22.2%. Conclusions: Pediatric patients with severe cranioencephalic trauma and tomographic alterations of Marshall III and IV presented a high chance of developing ICH.

RESUMO Objetivo: Determinar eventos associados à ocorrência de hipertensão intracraniana (HIC) em pacientes pediátricos com traumatismo cranioencefálico grave. Métodos: Trata-se de coorte prospectiva de pacientes de até 18 anos, com traumatismo cranioencefálico, pontuação abaixo de nove na Escala de Coma de Glasgow e monitoração da pressão intracraniana, admitidos entre setembro de 2005 e março de 2014 em unidade de terapia intensiva pediátrica. A HIC foi definida como episódio de pressão intracraniana acima de 20 mmHg por mais de cinco minutos e com necessidade de tratamento. Resultados: Incluídas 198 crianças e adolescentes, 70,2% masculinos, mediana de idade de nove anos. A HIC ocorreu em 135 (68,2%) pacientes; valor máximo de pressão intracraniana de 36,3; mediana 34 mmHg. Receberam sedação e analgesia para tratamento da HIC 133 (97,8%) pacientes, 108 (79,4%) receberam bloqueadores neuromusculares, 7 (5,2%) drenagem de líquor, 105 (77,2%) manitol, 96 (70,6%) hiperventilação, 64 (47,1%) solução salina a 3%, 20 (14,7%) barbitúricos e 43 (31,9%) foram submetidos à craniectomia descompressiva. Os eventos associados à ocorrência de HIC foram os achados tomográficos à admissão de swelling (edema mais ingurgitamento) difuso ou hemisférico. A razão de chance para que pacientes com classificação tomográfica Marshall III (swelling difuso) apresentassem HIC foi 14 (IC95% 2,8-113; p<0,003) e para aqueles com Marshall IV (hemisférico) foi 24,9 (IC95% 2,4-676; p<0,018). A mortalidade foi de 22,2%. Conclusões: Pacientes pediátricos com traumatismo cranioencefálico grave e alterações tomográficas tipo Marshall III e IV apresentaram grande chance de desenvolver HIC.

Clinical and microbiological characteristics of community-acquired pneumonia associated with Streptococcus pneumoniae in adult patients in Mexico / Características clínicas y microbiológicas de la neumonía adquirida en la comunidad asociada con Streptococcus pneumoniae en pacientes adultos en México

The aim of this study was to assess the risk factors and clinical and microbiological characteristics of community-acquired pneumonia (CAP) in adult patients in Mexico. Streptococcus pneumoniae classified as the causative agent of CAP in adult patients and patients with invasive S. pneumoniae isolates presented to three tertiary teaching hospitals during the 15-year study period were selected. Serotyping and susceptibility testing were performed for all included isolates. Clinical and demographic data were recorded. A total of 96 patients infected with S. pneumoniae (71 with CAP, 25 with invasive disease) were included. The CAP group involved more males (74.6%) than the invasive disease group (p = 0.03). Head trauma was more common in the CAP group (21.1%) than in the invasive disease group (4.0%; p = 0.03). The most prevalent serotype was 19A, followed by serotypes 3 and 23F. After the introduction of the heptavalent conjugated pneumococcal vaccine (PCV7), the prevalence of included serotypes declined significantly; no such change was found after the introduction of the PCV13 vaccine, including in the prevalence of serotype 19A. Susceptibility to all antimicrobials tested except vancomycin declined over the study period. In conclusion, head trauma was the most common comorbidity in the CAP group. The most prevalent serotype was 19A. Decreased susceptibility to most antimicrobials tested was observed.

El objetivo de este estudio fue evaluar los factores de riesgo y las características clínicas y microbiológicas de la neumonía adquirida en la comunidad (NAC) en pacientes adultos en México. Se seleccionaron pacientes adultos con NAC con Streptococcus pneumoniae como agente causal y pacientes con aislamientos invasivos de S. pneumoniae que concurrieron a tres hospitales de enseñanza de tercer nivel durante el período de estudio de 15 anos (2000-2015). Se realizaron pruebas de serotipificación y sensibilidad con todos los aislados incluidos. Se colectaron los datos clínicos y demográficos. Se incluyeron en total 96 pacientes infectados con S. pneumoniae (71 con NAC y 25 con enfermedad invasiva). El grupo con NAC incluía más varones (74,6%) que el grupo de enfermedad invasiva (p = 0,03). El traumatismo craneoencefálico fue más frecuente en el grupo NAC (21,1%) queen el grupo con enfermedad invasiva (4,0%; p = 0,03). El serotipo más frecuente fue 19A, seguido de los serotipos 3 y 23F. Después de la introducción de la vacuna antineumocócica conjugada heptavalente (PCV7), la prevalencia de los serotipos incluidos en aquella disminuyó significativamente; no sucedió lo mismo después de la introducción de la PCV13, incluso en relación con la prevalencia del serotipo 19A. La sensibilidad a todos los antimicrobianos evaluados, excepto la vancomicina, disminuyó durante el período de estudio. En conclusión, el traumatismo craneoencefálico fue la comorbilidad más frecuente en el grupo con NAC. El serotipo más frecuente fue el 19A, y se observó disminución de la sensibilidad a la mayoría de los antimicrobianos probados a lo largo del período considerado.

Estrategias para el empleo optimizado de la neuroimagenología en pacientes con traumatismo encéfalo craneano: puesta al día / Strategies for the optimized use of neuroimaging in patients with head trauma cranial: update

INTRODUCTION: Introduction of current neuroimaging technologies has been essential for the agile and effective diagnosis of cranial brain injuries. However, for various reasons there is a tendency to indiscriminate use. A review of the topic was made aimed at providing an update on the recommended strategies for the optimized use of these technologies. Material and method: A review of the topic of the last five years was made, using the Medline / Pubmed and SciELO platforms of complete articles, in English and Spanish. We also included relevant articles, published in previous years, located in previous bibliographic reviews carried out by the authors. CONCLUSIONS: Routine study with CT scan in all patients with head trauma is not cost effective, should be used in patients with Glasgow less than 15 points or in those with Glasgow of 15 points and risk factors of intracranial injury. Its use as a form of neuromonitoring is similarly useful, but on a selective basis. Magnetic Resonance Imaging is especially useful in the mediate or late periods of cranial trauma, in patients with clinical tomographic incongruences, very useful to establish prognosis in diffuse traumas and intracranial complications. Neurosonology is a useful tool for therapeutic decision.

Análisis de la frecuencia de pacientes politraumatizados en accidentes en motocicleta en la población pediátrica atendida en el Hospital Pediátrico de Sinaloa entre los años 2015 y 2017 / Analysis of the frequency of polytraumatized patients in motorcycle accidents in the pediatric publication attended in the Pediatric Hospital of Sinaloa between the years 2015 and 2017

Resumen: Objetivos: Determinar la frecuencia de los pacientes pediátricos politraumatizados involucrados en accidentes por motocicleta atendidos en el Hospital Pediátrico de Sinaloa entre los años 2015 y 2017, así como determinar la frecuencia de traumatismos craneoencefálicos, lesiones torácicas, abdominales, en extremidades, días de estancia hospitalaria y mortalidad. Material y métodos: La población seleccionada fueron pacientes menores de 18 años de edad que se encontraron involucrados en accidentes de motocicleta atendidos en el Hospital Pediátrico de Sinaloa en un período comprendido entre el 1o de Enero de 2015 al 31 de Diciembre de 2017. Resultados: El género más afectado fue el masculino, con edad más frecuente de 14 años, los accidentes ocurrieron con mayor frecuencia los Viernes y Sábados en horario nocturno. Julio fue el mes con mayor índice de accidentes. La cantidad de accidentes se incrementó cada año. La mayoría de los lesionados fueron pasajeros, 98.4% no utilizó equipo de seguridad, la lesión más común fue el traumatismo craneoencefálico, seguido de lesiones en extremidades inferiores, superiores, traumatismo torácico y la menos común, el traumatismo abdominal. Discusión: Hay un incremento progresivo en los accidentes en motocicleta donde se involucra la población pediátrica, el uso de casco es casi nulo, la mayoría de los pacientes presentó traumatismo craneoencefálico, este estudio sirve para analizar el panorama actual, así como ser la base de estudios posteriores y realizar más campañas para la prevención de accidentes en motocicleta y fomentar el uso de casco en pacientes pediátricos.

Abstract: Objectives: Determine the frequency of polytraumatized pediatric patients involved in motorcycle accidents treated at the Pediatric Hospital of Sinaloa between 2015 and 2017, as well as to determine the frequency of traumatic brain injuries, thoracic, abdominal, limb injuries, days of hospital stay and mortality. Material and methods: The selected population were patients under 18 years of age who were involved in motorcycle accidents treated at the Pediatric Hospital of Sinaloa in a period between January 1st, 2015 and December 31, 2017. Results: The most affected gender was the male with the most frequent age of 14 years, accidents occurred more frequently on Fridays and Saturdays at night. July was the month with the highest frequency of accidents. The number of accidents increased every year. Most of the injured were passengers, 98.4% did not use safety equipment, the most frequent injury was head injury, followed by injuries in lower extremities, upper chest trauma and less frequent abdominal traumatism. Discussion: There is a progressive increase in motorcycle accidents where the pediatric population is involved, the use of helmet is almost zero, most of the patients presented with head trauma, this study serves to see the current situation, as well as being the basis for Subsequent studies and conduct more campaigns for the prevention of motorcycle accidents and encourage the use of helmet in pediatric patients.

Caracterización clínico-quirúrgico, neuroimagenológico y por neuromonitorización del trauma craneoencefálico en la provincia matanzas. 2016-2018 / Clinical-surgical, neuroimaging and neuromonitored characterization of the encephalococranial trauma in the province of Matanzas. 2016-2018

RESUMEN Introducción: el traumatismo encefalocraneano es una causa frecuente de mortalidad y morbilidad. Según datos epidemiológicos aporta la mayor cantidad de fallecidos en menores de 45 años a nivel mundial. Objetivo: caracterizar el trauma craneoencefálico desde el punto de vista clínico-quirúrgico, neuroimagenológico y por neuromonitorización en los pacientes investigados. Materiales y métodos: estudio observacional, descriptivo, transversal, en el Servicio de Neurocirugía del Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane y Comandante Faustino Pérez Hernández, de Matanzas, durante el periodo comprendido entre enero del 2016 a enero del 2018. Resultados: predominó el sexo masculino con el 71,7% de los casos, la mayor prevalencia estuvo en edades inferiores a 48 años con el 80,1 %. La mayor cantidad presentaba un traumatismo encefalocraneano leve con el 56% de los casos seguido del traumatismo encefalocraneano moderado y severo con el 29% y 15% de los casos respectivamente. Predominaron las fracturas lineales (45,8%), seguido de las contusiones sin efecto de masa y los hematomas subdurales con el 24,2% y 23,3%. La mayoría de los pacientes presentó una escala de Marshall II con el 40,8%. Las cifras de presión intracraneal entre de 20-40 mmHg se presentó con mayor frecuencia (44,4 %). Conclusiones: la mitad de los pacientes neuromonitorizados presentaron una saturación del golfo de la vena yugular dentro de parámetros normales con el 50%. La operación más practicada fue la evacuación de hematomas subdurales con el 29,4%.

ABSTRACT Introduction: the encephalocranial trauma (ECT) is a frequent cause of mortality and morbidity. According to epidemiological data, it causes the highest number of deaths in people aged less than 45 years worldwide. Objective: to characterize the encephalocranial trauma from the clinical-surgical, neuroimaging and neuromonitoring point of view in the studied patients. Materials and methods: observational, descriptive, cross-sectional study carried out in the Neurosurgery Service of the Provincial Teaching Surgical Clinical Hospitals "Jose Ramon Lopez Tabrane" and "Comandante Faustino Perez Hernandez", of Matanzas, during the period from January 2016 to January 2018. Results: male sex predominated with 71.7% of the cases; the highest prevalence was in ages below 48 years with 80.1%. Most of them presented a mild encephalocranial trauma with 56% of the cases followed by moderate and severe encephalocranial trauma with 29% and 15% of the cases respectively. Linear fractures predominated (45.8%), followed by contusions without mass effect and subdural hematomas with 24.2% and 23.3%. Most of patients presented a Marshall II scale with 40.8%. The intracranial pressure between 20-40 mmHg occurred more frequently (44.4%). Conclusions: half of the neuromonitored patients presented jugular vein gulf saturation within normal parameters with 50%. The most practiced operation was the evacuation of subdural hematomas with 29.4%.

Prevalência de sequelas neurológicas associadas a trauma em face / Prevalence of neurological sequelae associated with facial trauma

Introdução: pacientes acometidos por traumatismo craniofacial podem evoluir com sequelas variadas. Objetivo: identificar a prevalência de sequelas neurológicas ocorridas entre os pacientes com traumatismo craniofacial em um serviço de referência para o trauma no sul do Brasil. Sujeitos e método: foram analisados 1.385 prontuários, em que 169 (12%) pacientes foram selecionados com trauma em crânio e face simultaneamente, levando em consideração o agente etiológico, a procedência, a idade, o sexo do paciente e a localização das fraturas. Resultados: uma taxa de 85% dos indivíduos era do sexo masculino, com faixa etária entre 31-40 anos. Os fatores etiológicos mais prevalentes foram acidentes de trânsito (36%), quedas (22%) e violência interpessoal (21%). No grupo selecionado, o traumatismo cranioencefálico esteve presente em 89% dos casos; em 64% da população, não houve sequela neurológica; 28% apresentaram algum tipo de sequela; e em 8% dos prontuários não havia informações completas. Conclusão: na população estudada, mesmo com um subgrupo específico de traumatizados, houve prevalência de gênero masculino, terceira década de vida e acidente automobilístico. Além disso, a região anatômica mais acometida foi o conjunto de ossos do terço médio da face, e, ainda nesta condição de associação, o traumatismo cranioencefálico esteve presente na maioria dos casos, porém, somente 28% dos casos evoluíram com alguma sequela neurológica. (AU)

Introduction: patients affected by craniofacial trauma may evolve into various sequelae. Objective: to identify the prevalence of neurological sequelae among patients with craniofacial trauma in a reference trauma service in southern Brazil. Subjects and method: a total of 1.385 medical records were analyzed, from which 169 (12%) patients were selected with simultaneous skull and face trauma, considering the etiologic agent, origin, age and sex of the patient, and fracture location. Results: a rate of 85% of the individuals were men aged 31 through 40 years. The most prevalent etiological factors were car accidents (36%), falls (22%), and interpersonal violence (21%). In this selected group, traumatic brain injury was present in 89% of the cases. In 64% of the population, there were no neurological sequelae, 28% presented some type of sequelae, and 8% of the medical records did not contain complete information. Conclusion: for this population studied, even with a specific subgroup of traumatized subjects, the male sex, the third decade of life, and car accidents are the most prevalent factors. In addition, the most affected anatomic region is the set of bones in the middle third of the face and, in this condition of association, traumatic brain injury was present in the great majority of cases, but only 28% of them evolved into some type of neurological sequelae. (A)

Orofacial injuries in children and adolescents (2009-2013): a 5-year study in Porto, Portugal

Abstract The aim of this study was to verify the prevalence of acts of aggression to the head, face and neck towards victims of Physical Violence against Children and Adolescents (PVCA) who were examined at the National Institute of Legal Medicine and Forensic Sciences Delegation North (INMLCF-DN) in Porto, Portugal. A study was carried out on 2,148 complaints of physical aggression against children and adolescents (0 to less than 18 years old) occurred between 2009 and 2013 and which were retrieved from information about violence held on INMLCF-DN data files. Continuous variables were described and the association between them was verified by Chi-square or Fischer's Exact tests with 5% significance level. Within the 5-year timespan, 1,380 cases were identified with clinical relation with physical aggression. Most subjects evaluated were male adolescents and the most affected body region was the face, to which 747 injuries (24.7%) were recorded, with statistically significant association between sex and region (head and face). Victims in 15-17-year-old age group are more susceptible to violence than those in the 0-14-year-old age range. Dentists routinely examine the face, neck and skull, which make them the most appropriate health professionals to identify cases of aggression early.

Resumo O objetivo deste estudo foi verificar a prevalência de atos de agressão à cabeça, face e pescoço em relação às vítimas de Violência Física contra Crianças e Adolescentes (PVCA) que foram examinadas no Instituto Nacional de Medicina Legal e Delegação de Ciências Forenses Norte (INMLCF -DN) no Porto, Portugal. Um estudo foi realizado em 2.148 queixas de agressão física contra crianças e adolescentes [0 a menores de 18 anos] ocorridas entre 2009 e 2013 e que foram recuperadas de informações sobre violência mantidas em arquivos de dados do INMLCF-DN. Variáveis contínuas foram descritas para verificar a suas correlações foram usados os testes do Chi-Quadrado e o Teste Exato de Fisher em um nível de significância de 5%. Nestes 5 anos, foram detectados 1.380 casos que apresentam nexo clínico com agressão física. As vítimas mais acometidas eram adolescentes do sexo masculino, a região do corpo mais atingida foi a face com 747 das lesões (24,7%) registradas. Há significância estatística no teste do qui-quadrado de Pearson na relação de gênero com a cabeça e o rosto. Dentistas rotineiramente examinam o crânio, rosto e pescoço que os torna os profissionais mais adequados para identificar casos de agressão precoce. Os adolescentes são mais suscetíveis à violência do que as crianças menores de 12 anos.

Epidemiologia de traumatismo craniencefálico em um hospital / Epidemiology of cranioencephalic trauma in a hospital

OBJETIVO: Analisar o perfil epidemiológico de vítimas de traumatismo craniencefálico. MÉTODOS: Estratificação de uma amostra de 4.466 pacientes com traumatismo craniencefálico de um hospital de Uberlândia (MG), entre 2010 e 2015, acordo com a ocorrência anual. Os pacientes foram divididos em grupos de idade e sexo, utilizando o Excel. RESULTADOS: Os homens foram as principais vítimas dos traumatismos craniencefálicos em todas as faixas etárias e em todos os anos analisados neste estudo, principalmente em idades inferiores a 40 anos. CONCLUSÃO: O sexo masculino e a idade até 40 anos tendem a ser fatores risco para o traumatismo craniencefálico. Os resultados desta análise podem justificar medidas de prevenção direcionadas para este grupo de risco, no sentido de reduzir a morbimortalidade.(AU)

OBJECTIVE: To analyze the epidemiological profile of cranioencephalic trauma (CET) patients. METHODS: Stratification of a sample of 4,466 patients with cranioencephalic trauma of a hospital in the city of Uberlândia, state of Minas Gerais, between 2010 and 2015, according to an yearly occurrence. The patients were divided in in age and gender groups, with the use of Excel. RESULTS: Men were the main victims of cranioencephalic trauma in all age groups and in all the years analyzed in this study, especially in the ages below 40 years. CONCLUSION: Males and ages up to 40 years tend to be at risk for cranioencephalic trauma. The results of this analysis may warrant prevention measures directed to this risk group to reduce morbidity and mortality.(AU)

Epidemiological Aspects of Cranioencephalic Trauma at Cuiabá Municipal Hospital, Brazil / Aspectos Epidemiológicos de los Traumatismos Craneoencefálicos Atendidos en el Hospital Municipal de Cuiabá, Brasil

ABSTRACT: Cranioencephalic trauma (CET) is defined is the combination of neural and vascular injuries and their inflammatory effects in the brain, skull and scalp. This modality of trauma may lead to motor, psychological and cognitive sequels or even death. The present study aimed to assess the main epidemiological aspects in victims of CET treated at Cuiabá Municipal Hospital (CMH), Brazil. An observational and analytical study was performed in the medical records of patients diagnosed with CET treated at CMH between July and December of 2000, 2006 and 2011. The information retrieved from the patients consisted of age, sex, place of residence, cause of trauma, association with other trauma, outcomes (death or discharge) and the severity of neurological effect (Glasgow Coma Scale). The data obtained was analyzed descriptively with absolute (n) and relative (%) quantification. Medical records of 669 victims were analyzed, out of which 567 were males (84.7 %). Male patients were aged between 20 and 39 years old (mean age: 32.8 years). The most prevalent cause of trauma was the motorcycle accident (26.6 %). The neurological severity of the CET was mild in most of the cases (32.5 %). Considering the place of residence, most of the patients (n=331; 49.5 %) were from the capital city of Mato Grosso State (Cuiabá, Brazil). Four-hundred seventy-nine (71.6 %) patients progressed without death. A high prevalence rate of CET was observed at CMH. Major attention must be given to young adult victims of motorcycle accidents.

RESUMEN: El traumatismo craneoencefálico (TCE) se define como una combinación de daño neural, insuficiencia vascular y efectos inflamatorios que comprometen el cráneo, el encéfalo y el cuero cabelludo, causando la muerte, o serias secuelas motoras, psicológicas y cognitivas. De esta forma, el objetivo de este trabajo fue evaluar los principales aspectos epidemiológicos en victimas de Traumatismo Craneoencefálico (TCE) atendidas en el Hospital y Sala de Primeros Auxilios Municipal de Cuiabá (HPSMC), Brasil. Se trata de un estudio observacional de historias clínicas del archivo del HPSMC, admitidos con diagnóstico de TCE en el período de julio a diciembre de los años 2000, 2006 y 2011. Se consideraron el rango de edad, el sexo, la procedencia de las víctimas, la causa del trauma, la asociación con otros traumas, la defunción y el alta, el cuadro neurológico (Escala de Coma de Glasgow - ECG). El análisis de los datos fue descriptivo con números absolutos y porcentajes. Se evaluaron historias clínicas de 669 víctimas de TCE, en los que el sexo masculino fue el de mayor prevalencia con 567 casos (84,7 %), con mayor incidencia en el rango de edad de 20 a 39 años (39,2 %), el promedio de edad fue de 32,8 años, siendo la etiología más frecuente los accidentes motociclísticos (26,6 %). En el momento de la admisión de acuerdo al ECG hubo una predominancia de TCE leve (32,5 %). En cuanto a la procedencia, 331 (49,5 %) eran del municipio de Cuiabá. Del total de víctimas, 479 (71,6 %) evolucionaron hasta tener el alta hospitalaria. Se registró una prevalencia elevada de TCE en el HPSMC, con predominancia de víctimas adultas jóvenes de sexo masculino, siendo los accidentes motociclísticos la principal causa.

Head injury burden in a major referral hospital emergency centre in Botswana

Introduction:This study describes the demographics, aetiology, emergency centre diagnosis and severity indicators of patients with head injuries presenting to the largest referral hospital emergency centre in Botswana.Methods:Cross-sectional retrospective data was collected from July 2015 to September 2015 for all emergency centre head injury presentations at Princess Marina Hospital. Information was extracted from emergency centre records regarding patient demographics, mechanism of injury, clinical observations, diagnosis, and treatment.Results:Three-hundred and sixty head injury patients presented to the emergency centre in the three months, averaging four per day. 80% were less than 40 years of age and males accounted for 69% of all presentations. 58% of injuries were listed as being accidental, 39% recorded from assaults and 38% from road traffic accidents. The most common emergency centre clinical diagnosis was concussion and the most common radiological diagnosis skull fracture. The median Glasgow Coma Scale was 15 with a range from 3 to 15; and, among patients for whom Revised Trauma Score could be calculated, 79% scored the lowest probability of death in the Revised Trauma Score.Discussion:Head injury disproportionately overburdened males in this study, and head injury aetiology and demographic picture was similar to regional data. Severity scoring using the Glasgow Coma Scale was only available among 66% of patients and Revised Trauma Score calculable in half of presentations. Only 55% of head injury patients were discharged from the emergency centre, despite the preponderance of low severity scores. Head CTs appear to have been over-utilised and implementation of a Traumatic Head CT guideline for our setting is proposed. This study improves understanding of the burden of head injury in Botswana and advocates for national referral guidelines for patients with head injury in Botswana

Traumatismes crâniens de l'enfant: aspects épidémiologiques et prise en charge au Centre Hospitalier Universitaire de Brazzaville

Introduction. Le but de cette étude était d'évaluer les conditions de prise en charge des traumatismes crâniens de l'enfant au Centre Hospitalier Universitaire (CHU) de Brazzaville. Méthodologie. Nous avons revu les dossiers des enfants âgés d'un mois à 17 ans, hospitalisés dans le service de chirurgie polyvalente du CHU de Brazzaville entre janvier 2014 et décembre 2015, et avons retenu ceux qui l'étaient pour un traumatisme crânien. Les paramètres épidémiologiques, diagnostiques, thérapeutiques et évolutifs ont été analysés. Résultats. sur 66 enfant hospitalisés, 48 (72,72%) ont été admis pour un traumatisme crânien et parmi eux 45 (68,18%) enfants ont été inclus dont 33 garçons et 12 filles. Leur âge moyen était de 9,73 ans. Le traumatisme était consécutif à un accident de la voie publique dans 36 cas (80%), à une chute dans 6 cas (13,33%), et à une agression dans 3 cas (6,66%). Le score de Glasgow était inférieur ou égal à huit dans 12 cas (26,66%), compris entre 9 et 12 dans 25 cas (55,55%) et entre 13 et 15 dans 8 cas (17,77%). Le scanner crânio-encéphalique était réalisé en moyenne quatre jours après le traumatisme. Quatre enfants (8,88%) ont été opérés. L'évolution après 12 mois était favorable pour 26 enfants (78,79%) et 12 enfants ont été perdus de vue. Conclusion. la fréquence élevée des traumatismes crâniens chez l'enfant est liée aux accidents de la voie publique. Une prise en charge adéquate nécessite la disponibilité d'un scanner cranioencéphalique en urgence. Nous préconisons un renforcement de l'éducation et la communication s'agissant les accidents de la voie publique et la facilitation de l'accès à l'imagerie

Epidemiologia do traumatismo cranioencefálico no Brasil / Epidemiology of traumatic brain injury in Brazil

Introdução: O traumatismo cranioencefálico (TCE) é considerado a maior causa de morte e incapacidade em todo mundo, principalmente entre adultos jovens. No Brasil, estima-se que mais de um milhão de pessoas vivam com sequelas neurológicas decorrentes do TCE. Apesar da sua alta prevalência e taxas de incidência em constante elevação, estudos epidemiológicos permanecem escassos. Objetivo: Discutir as evidências disponíveis em relação ao perfil epidemiológico da população brasileira acometida por TCE. Métodos: Realizou- se uma revisão de literatura nas bases de dados SciELO, LILACS e PubMed. Os termos utilizados na busca foram traumatismo cranioencefálico, e/ou epidemiologia, e/ou Brasil. Para a busca no PubMed foram utilizados os termos em inglês traumatic brain injury, e/ou epidemiology, e/ou Brazil. Foram incluídos artigos originais, descritivos e de revisão que não restringiram a causa, a gravidade do TCE e a faixa etária estudada. Resultados: Foram encontrados oito estudos de 1993 a 2015, todos retrospectivos, sendo cinco deles realizados em hospitais de emergência e três baseados em bancos de dados. Indivíduos com menos de 40 anos, do sexo masculino foram os mais acometidos e as causas principais foram quedas e os acidentes de trânsito, destacando-se os motociclísticos. Conclusão: Estudos epidemiológicos robustos sobre o TCE no Brasil ainda são escassos. Todos os estudos foram retrospectivos e apenas dois apresentaram dados nacionais. Nesse contexto, estudos epidemiológicos de caráter prospectivo que investiguem de forma sistemática os fatores associados ao TCE, são urgentemente recomendados. (AU)

Introduction: Traumatic brain injury (TBI) is the leading cause of death and disability worldwide, especially among young adults. In Brazil, it is estimated that more than one million people live with disabilities due to TBI. Despite the high incidence of TBI and related socioeconomic burden, epidemiological studies are scarce. Objective: To discuss the available evidence regarding the epidemiological profile of Brazilian people victims of TBI. Methods: A literature review was conducted on the SciELO, LILACS and PubMed databases. The terms used were traumatic brain injury and/or epidemiology, and/or Brazil. Original, descriptive and review studies that investigated only one specific cause of TBI, only one level of severity or a specific age group were not included in the current review. Results: Eight retrospective articles published between 1993 and 2015 were included. Five studies were conducted in emergency hospitals and three studies were based on databases records. Men under 40 years old were the most affected group, and the main causes of TBI were falls and traffic accidents, especially involving motorcycle. Conclusion: Sound epidemiological studies on TBI are still rare. All studies included were retrospective and only two reported national data. In this scenario, prospective epidemiological studies that systematically investigate the profile of TBI victims in Brazil are urgently necessary. (AU)

Profil épidémiologique des traumatismes crânio-encéphaliques au Centre Hospitalier et Universitaire de Bouaké

Introduction : Les traumatismes crânio-encéphaliques représentent une des principales causes de mortalité dans le monde. L'étude de leur épidémiologie permet d'identifier les facteurs de risque pour mieux cibler les actions de prévention. Patients et méthodes : Il s'agissait d'une étude rétrospective descriptive réalisée au service de réanimation polyvalente du CHU de Bouaké de janvier 2013 à décembre 2014. Elle concernait les patients admis en réanimation pour un traumatisme crânio-encéphalique avec un score de Glasgow inférieur à 14. Les paramètres étudiés étaient : le sexe, l'âge, la profession, les circonstances de survenue les modalités de transport, le délai d'admission à l'hôpital et la durée d'hospitalisation. Résultats : Au total 1244 patients ont été hospitalisés durant la période d'étude, dont 92 pour un traumatisme crânio-encéphalique, soit une prévalence hospitalière de 7,39%. Il y avait 86 hommes et 6 femmes. L'âge moyen était de 32,6 ans ± 17,03 (extrêmes 2 à 76 ans). Les conducteurs de mototaxi et les élèves étaient concernés dans respectivement 49% et 24% des cas. Les étiologies étaient dominées par les accidents de la voie publique (87%) qui impliquaient les engins à deux roues motorisés dans 40% des cas. Le transfert des patients a été effectuée par le groupement des sapeurs-pompiers militaires dans 48,9% des cas. L'admission des patients s'est faite dans 61% des cas avant la 6e heure suivant le traumatisme et le délai moyen d'admission était de 3 heures. La durée moyenne de séjour était de 4,37 ± 4,23 jours (extrêmes 1 à 21 jours). La mortalité globale était de 66%. Conclusion : Les traumatismes crânio-encéphaliques sont fréquents à Bouaké et font suite à un accident de la voie publique impliquant un engin motorisé à deux roues dans la majorité des cas. La prévention repose sur la sensibilisation au respect du code de la route

Impact de la loi portant sur l'obligation du port du casque à Cotonou sur les traumatismes crânio-encéphaliques

Le 2 août 2014, la loi sur le port obligatoire du casque pour les motocyclistes est entrée en application dans sa phase répressive à Cotonou. Ce travail a pour but d'évaluer l'impact de cette loi sur la fréquence, la morbidité, la mortalité et le coût de la prise en charge des Traumatisés Crânio-Encéphaliques au Centre National Hospitalier Universitaire Hubert Koutoukou Maga (CNHU/HKM) de Cotonou.Une étude prospective sur les facteurs socioéconomiques des TCE avait été initiée du 1er au 31 décembre 2014. C'est durant cette enquête, que la loi sur le port obligatoire du casque par les motocyclistes est entrée en application dans sa phase répressive. Nous avons déduit de cette enquête cette étude comparative, entre le 1er janvier et le 31 juillet 2014 puis entre le 2 août 2014 et le 31 décembre 2014. Parmi les 461 cas d'accidents de la voie publique, 347 (75,27%) étaient des accidents de moto dont 283 (81,55%) touchaient des conducteurs et 63 (18,15%) des passagers. La fréquence du port du casque, parmi les victimes de Traumatismes Crâniens Encéphaliques (TCE), a significativement augmenté de 2,3% à 34,5%. Après l'entrée en vigueur de la loi, On a observé une diminution de la fréquence des TCE de 55,54% mais la fréquence de la gravité et de la mortalité était comparable.Les accidents de moto étaient la cause majeure des TCE admis aux CNHU/HKM. La loi sur le port du casque par les motocyclistes a permis de réduire de façon significative la fréquence des TCE. Mais l'impact sur la mortalité des TCE reste faible