Lateral impact in closed head injury: A substantially increased risk for diffuse axonal injury—A preliminary study

Zwahlen, Roger Arthur; Labler, Ludwig; Trentz, Otmar; Grätz, Klaus Wilhelm; Bachmann, Lucas M. (2007). Lateral impact in closed head injury: A substantially increased risk for diffuse axonal injury—A preliminary study. Journal of cranio-maxillo-facial surgery, 35(3), pp. 142-146. Elsevier 10.1016/j.jcms.2007.01.006

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OBJECTIVE: Assessment, whether location of impact causing different facial fracture patterns was associated with diffuse axonal injury in patients with severe closed head injury. METHODS: Retrospectively all patients referred to the Trauma Unit of the University Hospital of Zurich, Switzerland between 1996 and 2002 presenting with severe closed head injuries (Abbreviated Injury Scale (AIS) (face) of 2-4 and an AIS (head and neck) of 3-5) were assessed according to the Glasgow Coma Scale (GCS) and the Injury Severity Score (ISS). Facial fracture patterns were classified as resulting from frontal, oblique or lateral impact. All patients had undergone computed tomography. The association between impact location and diffuse axonal injury when correcting for the level of consciousness (using the Glasgow scale) and severity of injury (using the ISS) was calculated with a multivariate regression analysis. RESULTS: Of 200 screened patients, 61 fulfilled the inclusion criteria for severe closed head injury. The medians (interquartile ranges 25;75) for GCS, AIS(face) AIS(head and neck) and ISS were 3 (3;13), 2 (2;4), 4 (4;5) and 30 (24;41), respectively. A total of 51% patients had frontal, 26% had an oblique and 23% had lateral trauma. A total of 21% patients developed diffuse axonal injury (DAI) when compared with frontal impact, the likelihood of diffuse axonal injury increased 11.0 fold (1.7-73.0) in patients with a lateral impact. CONCLUSIONS: Clinicians should be aware of the substantial increase of diffuse axonal injury related to lateral impact in patients with severe closed head injuries.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Bachmann, Lucas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1010-5182

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

07 Dec 2015 08:50

Last Modified:

24 Apr 2017 15:37

Publisher DOI:

10.1016/j.jcms.2007.01.006

PubMed ID:

17583523

BORIS DOI:

10.7892/boris.73928

URI:

https://boris.unibe.ch/id/eprint/73928

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