Potential benefit of a screening tool in selecting head-injured children aged 36 months or younger who can cooperate in computed tomography

Purpose@#We aimed to investigate the benefit of a screening tool in selecting head-injured children who can potentially cooperate with computed tomography (CT). @*Methods@#The study population consisted of head-injured children aged 36 months or younger who visited the emergency department (ED) and underwent CT from January 2013 through December 2020. Procedural sedation and analgesia (PSA) using per os chloral hydrate or per rectal thiopental was implemented to children presumed less cooperative for CT as per a clinical screening tool for cooperative candidates for CT (e.g., ability to lie still on bed for 10 seconds without a guardian). According to the PSA and the first attempt success of CT, we compared baseline characteristics, CT findings, clinically important traumatic brain injury, ED length of stay (EDLOS), and ED disposition. @*Results@#Among the 247 children, PSA was used in 102 (41.3%). The PSA group showed a higher proportion of 3-36 months of age (PSA, 96.1% vs. non-PSA, 82.8%; P = 0.001) and longer median EDLOS (PSA, 127.0 [interquartile range, 101.0-172.0] vs. non-PSA, 85.0 minutes [63.0-130.0]; P < 0.001). The number of children undergoing the first attempt success was 213 (86.2%) without a difference in both groups (PSA, 84.3% vs. non-PSA, 87.6%; P = 0.645). In the 213 children, the implementation of PSA was associated with longer median EDLOS (PSA, 121.0 [99.0-156.0] vs. non-PSA, 77.0 minutes [60.0-122.0]; P < 0.001). In the non-PSA group (n = 145), the first attempt failure was associated with the presence of skull fracture (success, 7.1% vs. failure, 27.8%; P = 0.009). @*Conclusion@#This study suggests a potential benefit of the screening tool in selecting cooperative candidates for CT, i.e., those who could forgo PSA using oral chloral hydrate or per rectal thiopental, in young children with head injury.

Diagnostic performance of brain computed tomography to detect facial bone fractures

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.

Anthropological Studies on the Proximal Femur of the Korean / 대한정형외과학회잡지

Anthropological studies of the proximal femur in a given race is a prerequisite step in designing femoral component of the total hip arthroplasty. As these studies and subsequent data are lacking for Korean hips, the author attempted an anthropological measurement of the Korean proximal femur. The results of this study are as following; l. In the orthoscanographic study for 187 subjects, mean of the maximum femoral length was 43.73±2.13cm for male, 40.53±2.03cm for female, The proportion of femoral length to the body height was found to have a constant ratio −26.10% for male, 25.91% for female. 2. In Anthropological measurement of Korean femur for 58 subjects, mean angle of the femoral anteversion was 19.85±6.86 and the neckshaft angle was 129.6±3.09. 3. In the study of the anterior curvature of femur, position index was 51.95±14.5% for male, 52.61±9.25% for female and index of bowing was 2.58±1.01% for male, 3.01±1.25% for female. In comparision with other races the Korean femur was found to have relatively straight curvature and the apex of the maximum curvature was located more distally. 4. External circumferential diameter of the femur-measured at 15cm below the lesser trochanter-showed 8.79±0.59cm for male and 8.42±0.53cm for female. The sexual difference at this level was statistically significant. (P <0.05). 5. In selected cadaeveric femurs, the minimum transverse diameter of internal mold was 1.26±0.30cm and was located at 12.5cm below the lesser trochanter to 20cm can be estimated by the following equation. Y=2.234−0.191X+0.0078X² for male, Y=2.395−0.173X+0.007X² for female.