Dataset Information

Fetal closed head injuries following maternal motor vehicle accident: A clinicopathologic case report.

ABSTRACT:

Rationale

The clinicopathologic appearance of fetal closed head injury (FCHI) due to a maternal motor vehicle accident has not been fully investigated because of its extreme rarity.

Patients concern

A 22-year-old woman at 31 weeks of gestation was riding in the front passenger seat of a car, and another rightward-turning car struck the right side of her vehicle.

Diagnosis

Uterine injury with placental abruption was strongly suspected.

Intervention

A live female infant in breech presentation was delivered by emergency caesarean section.

Outcomes

Although the female infant was and showed no evidence of trauma on her body surface. She exhibited a convulsion on the day of birth, and subsequent ultrasonography revealed possible intracranial hemorrhage. Although laboratory parameters associated with circulatory and respiratory function suggested a good response to the intensive care administered during the treatment course, the infant died 6 days later despite intensive care. Autopsy showed severe brain softening, subarachnoid hemorrhage with cerebral and cerebellar contusion, and bilateral thalamic hemorrhage. No hypoxic/ischemic changes of the thoracoabdominal organs were evident at autopsy.

Lessons

This was a clear case of FCHI by both shear and tensile forces. Multiple factors including the structural vulnerability of the fetal brain, the head posture of the fetus, the crash location and direction of force on the vehicle, and the employment of safety equipment may have contributed to the occurrence of FCHI in the present case.

SUBMITTER: Nishida N

PROVIDER: S-EPMC6221710 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Publications

Fetal closed head injuries following maternal motor vehicle accident: A clinicopathologic case report.

Nishida Naoki N Ina Shihomi S Hata Yukiko Y Nakanishi Yuko Y Ishizawa Shin S Futatani Takeshi T

Medicine 20181101 44

<h4>Rationale</h4>The clinicopathologic appearance of fetal closed head injury (FCHI) due to a maternal motor vehicle accident has not been fully investigated because of its extreme rarity.<h4>Patients concern</h4>A 22-year-old woman at 31 weeks of gestation was riding in the front passenger seat of a car, and another rightward-turning car struck the right side of her vehicle.<h4>Diagnosis</h4>Uterine injury with placental abruption was strongly suspected.<h4>Intervention</h4>A live female infan ...[more]

PMID: 30383704

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Project description:OBJECTIVE:The objective of the study was to develop a disability-based metric for motor vehicle crash (MVC) injuries, with a focus on head injuries, and compare the functional outcomes between the pediatric and adult populations. METHODS:Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System (NTDB-RDS) for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 3, 4, and 5 head injuries in NASS-CDS 2000-2011. Pediatric (ages 7-18), adult (19-45), middle-aged (46-65), and older adult (66+) patients with an FIM score available who were alive at discharge and had an AIS 3, 4, or 5 injury were included in the study. The NTDB-RDS contains a truncated form of the FIM instrument, including 3 items (self-feed, locomotion, and verbal expression), each graded on a scale of 1 (full functional dependence) to 4 (full functional independence). Patients within each age group were classified as disabled or not disabled based on the FIM scale. The DR was calculated for each age group by dividing the number of patients who sustained a specific injury and were disabled by the number of patients who sustained the specific injury. To account for the impact of more severe associated coinjuries, a maximum AIS (MAIS) adjusted DR (DRMAIS) was also calculated for each injury. DR and DRMAIS ranged from 0 (0% disability risk) to 1 (100% disability risk). RESULTS:An analysis of the most frequent FIM components associated with disabling MVC head injuries revealed that disability across all 3 items (self-feed, locomotion, and expression) was the most frequent for pediatric and adult patients. Only locomotion was the most frequent for middle-aged and older adults. The mean DRMAIS for MVC head injuries was 35% for pediatric patients, 36% for adults, 38% for middle-aged adults, and 44% for older adults. Further analysis was conducted by grouping the head injuries into 8 groups based on the structure of injury and injury type. The pediatric population possessed higher DRMAIS values for brain stem injuries as well as loss of consciousness injuries. Older adults possessed higher DRMAIS values for contusion/hemorrhage injuries, epidural hemorrhage, intracerebral hemorrhage, skull fracture, and subdural/subarachnoid hemorrhage. CONCLUSION:At-risk populations such as pediatric and older adult patients possessed higher DRMAIS values for different head injuries. Disability in pediatric patients is critical due to loss of quality life years. Disability risk can supplement severity metrics to improve the ability of such metrics to discriminate the severity of different injuries that do not lead to death. Understanding of age-related differences in injury outcomes when compared to adults could inform future age-specific modifications to the AIS.

Project description:BackgroundPatients who sustain a motor vehicle accident may experience long-term distress, even if they are uninjured or only slightly injured. There is a risk of neglecting patients with minor or no physical injuries, which might impact future health problems. The aim of this study was to explore patients' subjective experiences and perspectives on pain and other factors of importance after an early nursing intervention consisting of "caring touch" (tactile massage and healing touch) for patients subjected to a motor vehicle accident with minor or no physical injuries.MethodsA mixed method approach was used. The qualitative outcomes were themes derived from individual interviews. The quantitative outcomes were measured by visual analogue scale for pain (VAS, 0-100), sense of coherence (SOC), post-traumatic stress (IES-R) and health status (EQ-5D index and EQ-5D self-rated health). Forty-one patients of in total 124 eligible patients accepted the invitation to participate in the study. Twenty-seven patients completed follow-up after 6 months whereby they had received up to eight treatments with either tactile massage or healing touch.ResultsPatients reported that caring touch may assist in trauma recovery by functioning as a physical "anchor" on the patient's way of suffering, facilitating the transition of patients from feeling as though their body is "turned off" to becoming "awake". By caring touch the patients enjoyed a compassionate care and experience moments of pain alleviation. The VAS pain ratings significantly decreased both immediately after the caring touch treatment sessions and over the follow-up period. The median scores for VAS (p < 0.001) and IES-R (p 0.002) had decreased 6 months after the accident whereas the EQ-5D index had increased (p < 0.001). There were no statistically significant differences of the SOC or EQ-5D self-rated health scores over time.ConclusionsIn the care of patients suffering from a MVA with minor or no physical injuries, a caring touch intervention is associated with patients' report of decreased pain and improved wellbeing up to 6 months after the accident.Trial registrationClinicalTrials.gov Id: NCT02610205 . Date 25 November 2015.

Dataset Information

Fetal closed head injuries following maternal motor vehicle accident: A clinicopathologic case report.

Rationale

Patients concern

Diagnosis

Intervention

Outcomes

Lessons

Publications

Fetal closed head injuries following maternal motor vehicle accident: A clinicopathologic case report.

Similar Datasets

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