Trends in Traumatic Brain Injury Related to Consumer Products Among U.S. School-aged Children Between 2000 and 2019.

INTRODUCTION: Consumer product‒related traumatic brain injury in children is common, but long-term trends have not been well characterized. Understanding the long-term trends in consumer product‒related traumatic brain injury may inform prevention efforts. The study objective is to examine the trends in consumer product‒related traumatic brain injury in school-aged children. METHODS: Data were extracted from the National Electronic Injury Surveillance System-All Injury Program for initial emergency department visits for consumer product‒related traumatic brain injury (2000-2019) in school-aged children and analyzed in 2021. RESULTS: Approximately 6.2 million children presented to emergency department with consumer product‒related traumatic brain injury during 2000-2019. Consumer product‒related traumatic brain injury increased from 4.5% of overall consumer product‒emergency department visits in 2000 to 12.3% in 2019, and its incidence rate (cases per 100,000 population) was higher in males (681.2; 95% CI=611.2, 751.2) than in females (375.8; 95% CI=324.1, 427.6). The annual percentage change in consumer product‒related traumatic brain injury was 3.6% from 2000 to 2008, 13.3% from 2008 to 2012, and ‒2.0% through 2019. Average annual percentage change was higher in females (5.1%; 95% CI=3.4, 6.8) than in males (2.8%; 95% CI=1.6, 3.9). Consumer product‒related traumatic brain injury increased from 2000 to 2012 in females and then remained stable. In males, annual percentage change increased from 2008 to 2012 and then declined through 2019. CONCLUSIONS: Traumatic brain injury incidence rate in school-aged children increased from 2000 to 2019, peaked in 2012, and then declined in males but not in females. Percentage increases were highest in females. Prevention strategies should continue, with a specific focus on reducing consumer product‒related traumatic brain injury in female children.

Impact of transfer distance and time on rural brain injury outcomes.

OBJECTIVES: After rural injury, evaluation at local hospitals with transfer to regional trauma centres may delay definitive care. This study sought to determine the impact of such delays on outcomes in patients with TBI within a mature regional trauma system. METHODS: The ETMC Level 1 Trauma registry was queried from 2008-2013 for patients with blunt TBI, aged ≥ 18 and admitted ≤ 24 hours from injury and stratified them as 'transfer' vs 'direct' admission. Demographics, transfer distance, transfer times and outcomes were compared using Chi-square, t-test and multivariable logistic regression; p < 0.05 was significant. RESULTS: During the study period, 1845 patients met inclusion criteria: 947 'direct' and 898 'transfers'. For transfers, median distance was 60.1 miles; mean time to initial care was 1.2 ± 2.7 hours and time to Level 1 care was 5.0 ± 2.4 hours. Transfer patients were older (56 vs 49 years; p < 0.01) and had more comorbidities, but had lower mean ISS (15.9 vs 18.8; p < 0.01) and lower mortality (7.0 vs 10.3%; p < 0.03), complications and LOS. Neurosurgical intervention was comparable (p = 0.88), as was mortality for patients with ISS ≥ 15 (12.4% vs 14.8%; p = 0.28). After regression analysis, advanced age and increasing ISS, not distance or time, predicted mortality. CONCLUSION: Neither transfer distance nor time independently contributed to mortality for TBI after rural injury. An established regional trauma system, with initial local stabilization using ATLS principles, may help reduce negative outcomes for injured patients in rural settings.

Biomechanical comparison of facet-sparing laminectomy and Christmas tree laminectomy.

OBJECT: The authors compared differences in biomechanical stability between two decompressive laminectomy techniques for treating lumbar stenosis. A Christmas tree laminectomy (CTL), in which bilateral facetectomies and foraminotomies are performed, was compared with facet-sparing laminectomy (FSL), in which the facets are undercut but not resected. Spinal instability was assessed immediately postoperatively and again after discectomy to model long-term degeneration. METHODS: Sixteen motion segments obtained from five human cadaveric lumbar specimens were studied in vitro by conducting nondestructive flexibility tests. Specimens were tested intact, after FSL or CTL, and again after discectomy. Nonconstraining torques (< or = 5 Nm) were applied to induce flexion, extension, axial rotation, and lateral bending; strings and pulleys were used while vertebral angles were measured. Anteroposterior translation in response to shear loading (< or = 100 N) was also measured. Angular motion, shear motion, and sagittal-plane axes of rotation were compared to evaluate stability. Compared with the intact condition, CTL-treated specimens had significantly larger increases in angular motion during flexion, lateral bending, and axial rotation than their FSL-treated counterparts (p < 0.05, nonpaired Student t-tests). Subsequent discectomy caused greater increases in motion in the CTL group. Axes of rotation shifted less from their normal positions after FSL than after CTL. CONCLUSIONS: This study provides objective evidence that the treatment of lumbar stenosis with FSL induces less biomechanical instability and alters kinematics less than FSL. These findings support the use of the FSL in treating lumbar stenosis.

Biomechanical analysis of multilevel cervical corpectomy and plate constructs.

OBJECT: The authors compared the biomechanical stability of two multilevel cervical constructs involving the placement of equal size anterior cervical plates (ACPs) after decompressive surgery: the first is placed after three-level corpectomy with strut graft and the second after two-level corpectomy and aggressive discectomy with strut graft. In addition, both constructs were evaluated with and without the application of a screw attaching the ACP to the strut graft to determine whether the additional screw enhanced stability in any mode of loading. METHODS: Nondestructive repeated-measures in vitro flexibility tests were performed in human cadaveric cervical spines. Nonconstraining pure moments of up to 1.5 Nm were applied while recording three-dimensional angular motion stereophotogrammetrically at each level from C4-5 to C7-T1. Nine specimens underwent the three-level corpectomy/strut graft procedure and eight specimens the two-level corpectomy/discectomy strut graft procedure. Failures during testing eliminated two of the former specimens and three of the latter specimens from analysis. The construct applied after the two-level procedure allowed a significantly smaller normalized neutral zone during flexion-extension than the three-level construct (p = 0.04). Normalized elastic zone and range of motion were consistently smaller in the two- than in the three-level construct, but the differences were not significant. Addition of a screw to the strut graft significantly reduced motion in the three-level procedure-treated specimens during flexion and lateral bending but had no effect on two-level corpectomy-treated specimens. CONCLUSIONS: The construct associated with the two-level corpectomy/discectomy provided better immediate postoperative stability than that associated with the three-level corpectomy. The addition of a screw to the strut graft conferred stability on the three-level construct but not the two-level construct.

Modified classification of spinal cord vascular lesions.

The literature on spinal vascular malformations contains a great deal of confusing terminology. Some of the nomenclature is inconsistent with the lesions described. Based on the experience of the senior author (R.F.S.) in the treatment of more than 130 spinal cord vascular lesions and based on a thorough review of the relevant literature, the authors propose a modified classification system for spinal cord vascular lesions. Lesions are divided into three primary or broad categories: neoplasms, aneurysms, and arteriovenous lesions. Neoplastic vascular lesions include hemangioblastomas and cavernous malformations, both of which occur sporadically and familially. The second category consists of spinal aneurysms, which are rare. The third category, spinal cord arteriovenous lesions, is divided into arteriovenous fistulas and arteriovenous malformations (AVMs). Arteriovenous fistulas are subdivided into those that are extradural and those that are intradural, with intradural lesions categorized as either dorsal or ventral. Arteriovenous malformations are subdivided into extradural-intradural and intradural malformations. Intradural lesions are further divided into intramedullary, intramedullary-extramedullary, and conus medullaris, a new category of AVM. This modified classification system for vascular lesions of the spinal cord, based on pathophysiology, neuroimaging features, intraoperative observations, and neuroanatomy, offers several advantages. First, it includes all surgical vascular lesions that affect the spinal cord. Second, it guides treatment by classifying lesions based on location and pathophysiology. Finally, it eliminates the confusion produced by the multitude of unrelated nomenclatural terms found in the literature.