Accidental head trauma during care activities in the first year of life: a neurosurgical comparative study.

OBJECTIVES: This study aims to describe clinical-epidemiological data regarding accidental fall injuries occurring during homecare activities among children up to 1 year of age and to compare their outcomes according to the type of trauma. METHODS: We searched four different hospital databases on head injuries from 1999 to 2009. Patients recorded under the descriptors "accidental fall" and "home-related" in the subtext were selected. Patients were classified into two groups: those who flipped over and fell from a changing table (n = 253) and those who fell from the bed sustaining a direct impact from the floor (n = 483). RESULTS: There was no difference between both groups with respect to age, gender, and Glasgow Coma Scale score. However, children who suffered injuries after an accidental fall from the changing table were more likely to require surgery (26/483 vs. 57/253, p < 0.0001), had a mean longer length of stay (LOS, 4 vs. 1 day), and a higher incidence of depressed skull fractures (12/483 vs. 24/253, p < 0.0001). Children with a direct impact from the floor after falling off the bed were expected to suffer from simple linear skull fractures, while those who flipped over the changing table were more likely to present facial, soft tissue, or skeletal injuries. CONCLUSIONS: Children who flipped over a changing table during their homecare activities were more likely to require surgery, showed a higher morbidity, and showed a longer LOS than those who fell down from the bed. These results probably reflect the different impact energy according to each injury mechanism.

Microporous Polysaccharide Hemospheres (MPH) for cerebral hemostasis: a preliminary report.

OBJECTIVE: To report preliminary experience in using Microporous Polysaccharide Hemospheres (MPH; Medafor, Inc, Minneapolis, Minnesota, USA) for cerebral and dural sinus hemostasis. METHODS: Absorbable hemospheres for hemostasis were used in 10 patients (6 men, 4 women, mean age 56.2 years) undergoing cerebral procedures. The indication was corticosubcortical cerebral hemostasis after resection of meningiomas (n = 5) and gliomas (n = 5). In one case, absorbable hemospheres were applied for generalized oozing over the superior sagittal sinus. The surgical technique, time to bleeding control, and associated complications were recorded. RESULTS: Effective hemostasis, defined as cessation of oozing bleeding, was achieved no later than 2 minutes after topical agent application in all patients except two, in whom the hemostatic application was repeated. Mean follow-up was 12 months. No patient developed allergic reactions or systemic complications in association with hemostatic absorbable hemospheres. There was no case of cerebral hematoma, swelling, or infection after surgery. CONCLUSIONS: In this preliminary study, the direct application of absorbable hemospheres helped to control superficial cerebral bleeding, reducing the use of bipolar coagulation and shortening surgical time. Although use of absorbable hemospheres seems to be safe and effective, further investigations and prospective studies with longer follow-up are strongly recommended to arrive at final conclusions.