Motor vehicle crash-related subdural hematoma from real-world head impact data.

Abstract Approximately 1,700,000 people sustain a traumatic brain injury (TBI) each year and motor vehicle crashes (MVCs) are a leading cause of hospitalization from TBI. Acute subdural hematoma (SDH) is a common intracranial injury that occurs in MVCs associated with high mortality and morbidity rates. In this study, SDH volume and midline shift have been analyzed in order to better understand occupant injury by correlating them to crash and occupant parameters. Fifty-seven head computed tomography (CT) scans were selected from the Crash Injury Research Engineering Network (CIREN) with Abbreviated Injury Scale (AIS) level 3+ SDH. Semi-automated methods were used to isolate the intracranial volume. SDH and additional occupant intracranial injuries were segmented across axial CT images, providing a total SDH injury volume. SDH volume was correlated to crash parameters and occupant characteristics. Results show a positive correlation between SDH volume and crash severity in near-side and frontal crashes. Additionally, the location of the resulting hemorrhage varied by crash type. Those with greater SDH volumes had significantly lower Glasgow Coma Scale (GCS) scores at the crash site in near-side crashes. Age and fracture type were found to be significant contributors to SDH volume. This study is a volumetric analysis of real world brain injuries and known MVC impacts. The results of this study demonstrate a relationship among SDH volume, crash mechanics, and occupant characteristics that provide a better understanding of the injury mechanisms of MVC-associated TBI.

[1]  L H Pitts,et al.  Brain shift, level of consciousness, and restoration of consciousness in patients with acute intracranial hematoma. , 1989, Journal of neurosurgery.

[2]  Allen W. Brown,et al.  Relative risk of mortality after traumatic brain injury: a population-based study of the role of age and injury severity. , 2007, Journal of neurotrauma.

[3]  S. Dirusso,et al.  Mortality risk after head injury increases at 30 years. , 2003, Journal of the American College of Surgeons.

[4]  T. Mills,et al.  Indications for computed tomography in patients with minor head injury. , 2000, The New England journal of medicine.

[5]  Kristy B. Arbogast,et al.  Factors Associated With Clinically Significant Head Injury in Children Involved in Motor Vehicle Crashes , 2010, Traffic injury prevention.

[6]  Gabriel E Ryb,et al.  Injury severity and outcome of overweight and obese patients after vehicular trauma: a crash injury research and engineering network (CIREN) study. , 2008, The Journal of trauma.

[7]  Stephen A Ridella,et al.  Kinematic Rotational Brain Injury Criterion (BRIC) , 2011 .

[8]  S. Starkman,et al.  Lateral displacement of the brain and level of consciousness in patients with an acute hemispheral mass , 1986 .

[9]  L. Battistin,et al.  EFNS guideline on mild traumatic brain injury: report of an EFNS task force , 2002, European journal of neurology.

[10]  Ewout W Steyerberg,et al.  Prediction of Outcome in Traumatic Brain Injury with Computed Tomographic Characteristics: A Comparison between the Computed Tomographic Classification and Combinations of Computed Tomographic Predictors , 2005, Neurosurgery.

[11]  Jie Zhang,et al.  The ABCs of Accurate Volumetric Measurement of Cerebral Hematoma , 2011, Stroke.

[12]  Joel D. Stitzel,et al.  Modeling Brain Injury Response for Rotational Velocities of Varying Directions and Magnitudes , 2012, Annals of Biomedical Engineering.

[13]  Juan Lu,et al.  Prognostic value of computerized tomography scan characteristics in traumatic brain injury: results from the IMPACT study. , 2007, Journal of neurotrauma.

[14]  P. Chiewvit,et al.  Degree of midline shift from CT scan predicted outcome in patients with head injuries. , 2010, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[15]  George A Wells,et al.  The Canadian CT Head Rule for patients with minor head injury , 2001, The Lancet.

[16]  Narayan Yoganandan,et al.  Severe-to-fatal head injuries in motor vehicle impacts. , 2010, Accident; analysis and prevention.

[17]  Kristy B. Arbogast,et al.  Head Injury Causation Scenarios for Belted, Rear-Seated Children in Frontal Impacts , 2011, Traffic injury prevention.

[18]  J. Crisco,et al.  Rotational Head Kinematics in Football Impacts: An Injury Risk Function for Concussion , 2011, Annals of Biomedical Engineering.

[19]  R. MacCallum,et al.  Extended analysis of early computed tomography scans of traumatic brain injured patients and relations to outcome. , 2010, Journal of neurotrauma.

[20]  D. Becker,et al.  Value of skull radiography, head computed tomographic scanning, and admission for observation in cases of minor head injury. , 1988, Neurosurgery.

[21]  R. Bullock,et al.  Moderate and severe traumatic brain injury in adults , 2008, The Lancet Neurology.

[22]  Stefan M. Duma,et al.  Development of the STAR Evaluation System for Football Helmets: Integrating Player Head Impact Exposure and Risk of Concussion , 2011, Annals of Biomedical Engineering.

[23]  D. Bruce.  Imaging after head trauma: why, when and which , 2000, Child's Nervous System.

[24]  Peter Gruen,et al.  Surgical management of head trauma. , 2002, Neuroimaging clinics of North America.

[25]  Anne G Rizzo,et al.  Age: is it all in the head? Factors influencing mortality in elderly patients with head injuries. , 2011, The Journal of trauma.

[26]  P. Weninger,et al.  Factors influencing the injury pattern and injury severity after high speed motor vehicle accident--a retrospective study. , 2007, Resuscitation.

[27]  Steven Rowson,et al.  Linear and angular head acceleration measurements in collegiate football. , 2009, Journal of biomechanical engineering.

[28]  George F Borm,et al.  Computed tomography and outcome in moderate and severe traumatic brain injury: hematoma volume and midline shift revisited. , 2011, Journal of neurotrauma.

[29]  Ann Mallory,et al.  Head injury and aging: the importance of bleeding injuries. , 2010, Annals of advances in automotive medicine. Association for the Advancement of Automotive Medicine. Annual Scientific Conference.

[30]  O. Rienhoff,et al.  Three-dimensional reconstruction and volumetry of intracranial haemorrhage and its mass effect , 2005, Neuroradiology.

[31]  Narayan Yoganandan,et al.  Traumatic brain injury after frontal crashes: relationship with body mass index. , 2009, The Journal of trauma.

[32]  Joel D Stitzel,et al.  Investigating the effects of side airbag deployment in real-world crashes using crash comparison techniques. , 2011, Annals of advances in automotive medicine. Association for the Advancement of Automotive Medicine. Annual Scientific Conference.

[33]  Johannes Wikner,et al.  Comparison of ABC/2 estimation technique to computer-assisted planimetric analysis in warfarin-related intracerebral parenchymal hemorrhage. , 2006, Stroke.

[34]  L. Thibault,et al.  Biomechanics of acute subdural hematoma. , 1982, The Journal of trauma.

[35]  P. Kilgo,et al.  Age thresholds for increased mortality of three predominant crash induced head injuries. , 2008, Annals of advances in automotive medicine. Association for the Advancement of Automotive Medicine. Annual Scientific Conference.

[36]  B. Fildes,et al.  Demographics, Velocity Distributions, and Impact Type as Predictors of AIS 4+ Head Injuries in Motor Vehicle Crashes. , 2011, Annals of advances in automotive medicine. Association for the Advancement of Automotive Medicine. Annual Scientific Conference.

[37]  D Otte,et al.  Correlation between crash severity, injury severity, and clinical course in car occupants with thoracic trauma: a technical and medical study. , 2001, The Journal of trauma.

[38]  Hasan Kamil Sucu,et al.  The Value of XYZ/2 Technique Compared With Computer-Assisted Volumetric Analysis to Estimate the Volume of Chronic Subdural Hematoma , 2005, Stroke.

[39]  Anne T. McCartt,et al.  Efficacy of Side Airbags in Reducing Driver Deaths in Driver-Side Car and SUV Collisions , 2007, Traffic injury prevention.

[40]  H. Maxeiner,et al.  PURE SUBDURAL HEMATOMAS: A POSTMORTEM ANALYSIS OF THEIR FORM AND BLEEDING POINTS , 2002, Neurosurgery.