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Ray-Barruel G, Pather P, Schults JA, Rickard CM. Handheld Ultrasound Devices for Peripheral Intravenous Cannulation: A Scoping Review. JOURNAL OF INFUSION NURSING 2024; 47:75-95. [PMID: 38422403 DOI: 10.1097/nan.0000000000000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Ultrasound-guided insertion of peripheral intravenous catheters (PIVCs) is recommended for patients with difficult intravenous access, but access to ultrasound equipment is often limited to specialty departments. Compact, affordable handheld ultrasound devices are available, but the extent of their clinical adoption and impact on patient outcomes is unknown. This scoping review aimed to explore evidence regarding handheld and pocket ultrasound devices for PIVC insertion. Databases were searched for studies published in English between January 2000 and January 2023 evaluating handheld or pocket ultrasound devices weighing ≤3 kg for PIVC insertion. Data were extracted using standardized forms and summarized using descriptive statistics. Seventeen studies reporting the use of handheld or pocket ultrasound devices were identified. Most studies were conducted in adult inpatient facilities; 3 included pediatrics, and 2 reported out-of-hospital use. Participants with difficult intravenous access featured in 9 studies. Ultrasound training programs were described in 12 studies, with competency defined by number of successful PIVC insertions. Five studies reported clinician and/or patient perspectives. Ultrasound for PIVC insertion is not widely accessible in nonspecialist areas, but more compact and affordable handheld models could provide a solution, especially for patients with difficult access. More research evidence using handheld ultrasound is needed.
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Affiliation(s)
- Gillian Ray-Barruel
- School of Nursing, Midwifery and Social Work, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Herston Infectious Diseases Institute and Metro North Hospital and Health Service, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia (Ray-Barruel, Pather, Schults, Rickard); ICU Outreach, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia (Pather); Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Queensland, Australia (Schults)
- Gillian Ray-Barruel, PhD, RN, is a senior research fellow with the University of Queensland School of Nursing, Midwifery and Social Work and the Herston Infectious Diseases Institute (HeIDI), as well as an adjunct senior research fellow with Griffith University in Brisbane, Australia. She is also education director with the Alliance for Vascular Access Teaching and Research (AVATAR) and associate editor for the ACIPC journal Infection, Disease & Health. Following a successful 20-year career in critical care nursing and project management, Dr Ray-Barruel established her career as an internationally respected nurse researcher with over 70 peer-reviewed publications. Her research focuses on improving assessment and decision-making by bedside clinicians to prevent device-related patient complications and improve health care outcomes
- Priscilla Pather, RN, MAppSc (Research), is an emerging early career researcher and a clinical nurse consultant working with ICU Outreach at Queen Elizabeth II Jubilee Hospital, Brisbane, and a registered intensive care unit (ICU) nurse at Mater Health Services, South Brisbane. As a front-line clinician focused on early detection and management of the deteriorating patient, she has strong cannulation skills and is ideally placed between academia and clinical settings to conduct research and audits, as well as to promote and monitor developments in this field. She is invested in safety and quality, adopting evidence-based practice into clinical care to promote and preserve vessel health
- Jessica Schults, PhD, RN, is a conjoint senior research fellow with The University of Queensland School of Nursing, Midwifery and Social Work and Metro North's Herston Infectious Disease Institute. Her research themes to date have focused on ventilation strategies to reduce ventilator-associated pneumonia and interventions to improve the safety and quality of care related to invasive medical devices. Dr Schults's developing research themes focus on enhancing health service surveillance using electronic health information in 2 major spheres: hospital-level surveillance for hospital-acquired complications and unit-level surveillance for vascular access device complications and ventilator-associated events. She is particularly interested in advances in infectious disease surveillance and tracking, using a combination of mature platforms and new electronic platforms
- Claire M. Rickard, PhD, RN, is professor of infection prevention and vascular access at the University of Queensland and Metro North Health in Brisbane, Australia. She is also adjunct professor with Griffith University and board cochair of the Australian and New Zealand Intensive Care Foundation. She established and coleads the Alliance for Vascular Access Teaching and Research (avatargroup.org.au), a large collaborative with the vision to "make vascular access complications history." Her background is in critical care and med-surg nursing followed by a focus on clinical research leading to >300 publications, including 45 randomized controlled trials. She was recognized in the International Nurse Researcher Hall of Fame in 2013, and elected to the Australian Academy of Health and Medical Sciences in 2015 and the American Academy of Nursing in 2021
| | - Priscilla Pather
- School of Nursing, Midwifery and Social Work, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Herston Infectious Diseases Institute and Metro North Hospital and Health Service, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia (Ray-Barruel, Pather, Schults, Rickard); ICU Outreach, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia (Pather); Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Queensland, Australia (Schults)
- Gillian Ray-Barruel, PhD, RN, is a senior research fellow with the University of Queensland School of Nursing, Midwifery and Social Work and the Herston Infectious Diseases Institute (HeIDI), as well as an adjunct senior research fellow with Griffith University in Brisbane, Australia. She is also education director with the Alliance for Vascular Access Teaching and Research (AVATAR) and associate editor for the ACIPC journal Infection, Disease & Health. Following a successful 20-year career in critical care nursing and project management, Dr Ray-Barruel established her career as an internationally respected nurse researcher with over 70 peer-reviewed publications. Her research focuses on improving assessment and decision-making by bedside clinicians to prevent device-related patient complications and improve health care outcomes
- Priscilla Pather, RN, MAppSc (Research), is an emerging early career researcher and a clinical nurse consultant working with ICU Outreach at Queen Elizabeth II Jubilee Hospital, Brisbane, and a registered intensive care unit (ICU) nurse at Mater Health Services, South Brisbane. As a front-line clinician focused on early detection and management of the deteriorating patient, she has strong cannulation skills and is ideally placed between academia and clinical settings to conduct research and audits, as well as to promote and monitor developments in this field. She is invested in safety and quality, adopting evidence-based practice into clinical care to promote and preserve vessel health
- Jessica Schults, PhD, RN, is a conjoint senior research fellow with The University of Queensland School of Nursing, Midwifery and Social Work and Metro North's Herston Infectious Disease Institute. Her research themes to date have focused on ventilation strategies to reduce ventilator-associated pneumonia and interventions to improve the safety and quality of care related to invasive medical devices. Dr Schults's developing research themes focus on enhancing health service surveillance using electronic health information in 2 major spheres: hospital-level surveillance for hospital-acquired complications and unit-level surveillance for vascular access device complications and ventilator-associated events. She is particularly interested in advances in infectious disease surveillance and tracking, using a combination of mature platforms and new electronic platforms
- Claire M. Rickard, PhD, RN, is professor of infection prevention and vascular access at the University of Queensland and Metro North Health in Brisbane, Australia. She is also adjunct professor with Griffith University and board cochair of the Australian and New Zealand Intensive Care Foundation. She established and coleads the Alliance for Vascular Access Teaching and Research (avatargroup.org.au), a large collaborative with the vision to "make vascular access complications history." Her background is in critical care and med-surg nursing followed by a focus on clinical research leading to >300 publications, including 45 randomized controlled trials. She was recognized in the International Nurse Researcher Hall of Fame in 2013, and elected to the Australian Academy of Health and Medical Sciences in 2015 and the American Academy of Nursing in 2021
| | - Jessica A Schults
- School of Nursing, Midwifery and Social Work, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Herston Infectious Diseases Institute and Metro North Hospital and Health Service, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia (Ray-Barruel, Pather, Schults, Rickard); ICU Outreach, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia (Pather); Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Queensland, Australia (Schults)
- Gillian Ray-Barruel, PhD, RN, is a senior research fellow with the University of Queensland School of Nursing, Midwifery and Social Work and the Herston Infectious Diseases Institute (HeIDI), as well as an adjunct senior research fellow with Griffith University in Brisbane, Australia. She is also education director with the Alliance for Vascular Access Teaching and Research (AVATAR) and associate editor for the ACIPC journal Infection, Disease & Health. Following a successful 20-year career in critical care nursing and project management, Dr Ray-Barruel established her career as an internationally respected nurse researcher with over 70 peer-reviewed publications. Her research focuses on improving assessment and decision-making by bedside clinicians to prevent device-related patient complications and improve health care outcomes
- Priscilla Pather, RN, MAppSc (Research), is an emerging early career researcher and a clinical nurse consultant working with ICU Outreach at Queen Elizabeth II Jubilee Hospital, Brisbane, and a registered intensive care unit (ICU) nurse at Mater Health Services, South Brisbane. As a front-line clinician focused on early detection and management of the deteriorating patient, she has strong cannulation skills and is ideally placed between academia and clinical settings to conduct research and audits, as well as to promote and monitor developments in this field. She is invested in safety and quality, adopting evidence-based practice into clinical care to promote and preserve vessel health
- Jessica Schults, PhD, RN, is a conjoint senior research fellow with The University of Queensland School of Nursing, Midwifery and Social Work and Metro North's Herston Infectious Disease Institute. Her research themes to date have focused on ventilation strategies to reduce ventilator-associated pneumonia and interventions to improve the safety and quality of care related to invasive medical devices. Dr Schults's developing research themes focus on enhancing health service surveillance using electronic health information in 2 major spheres: hospital-level surveillance for hospital-acquired complications and unit-level surveillance for vascular access device complications and ventilator-associated events. She is particularly interested in advances in infectious disease surveillance and tracking, using a combination of mature platforms and new electronic platforms
- Claire M. Rickard, PhD, RN, is professor of infection prevention and vascular access at the University of Queensland and Metro North Health in Brisbane, Australia. She is also adjunct professor with Griffith University and board cochair of the Australian and New Zealand Intensive Care Foundation. She established and coleads the Alliance for Vascular Access Teaching and Research (avatargroup.org.au), a large collaborative with the vision to "make vascular access complications history." Her background is in critical care and med-surg nursing followed by a focus on clinical research leading to >300 publications, including 45 randomized controlled trials. She was recognized in the International Nurse Researcher Hall of Fame in 2013, and elected to the Australian Academy of Health and Medical Sciences in 2015 and the American Academy of Nursing in 2021
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Herston Infectious Diseases Institute and Metro North Hospital and Health Service, Brisbane, Queensland, Australia (Ray-Barruel, Schults, Rickard); Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia (Ray-Barruel, Pather, Schults, Rickard); ICU Outreach, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia (Pather); Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Queensland, Australia (Schults)
- Gillian Ray-Barruel, PhD, RN, is a senior research fellow with the University of Queensland School of Nursing, Midwifery and Social Work and the Herston Infectious Diseases Institute (HeIDI), as well as an adjunct senior research fellow with Griffith University in Brisbane, Australia. She is also education director with the Alliance for Vascular Access Teaching and Research (AVATAR) and associate editor for the ACIPC journal Infection, Disease & Health. Following a successful 20-year career in critical care nursing and project management, Dr Ray-Barruel established her career as an internationally respected nurse researcher with over 70 peer-reviewed publications. Her research focuses on improving assessment and decision-making by bedside clinicians to prevent device-related patient complications and improve health care outcomes
- Priscilla Pather, RN, MAppSc (Research), is an emerging early career researcher and a clinical nurse consultant working with ICU Outreach at Queen Elizabeth II Jubilee Hospital, Brisbane, and a registered intensive care unit (ICU) nurse at Mater Health Services, South Brisbane. As a front-line clinician focused on early detection and management of the deteriorating patient, she has strong cannulation skills and is ideally placed between academia and clinical settings to conduct research and audits, as well as to promote and monitor developments in this field. She is invested in safety and quality, adopting evidence-based practice into clinical care to promote and preserve vessel health
- Jessica Schults, PhD, RN, is a conjoint senior research fellow with The University of Queensland School of Nursing, Midwifery and Social Work and Metro North's Herston Infectious Disease Institute. Her research themes to date have focused on ventilation strategies to reduce ventilator-associated pneumonia and interventions to improve the safety and quality of care related to invasive medical devices. Dr Schults's developing research themes focus on enhancing health service surveillance using electronic health information in 2 major spheres: hospital-level surveillance for hospital-acquired complications and unit-level surveillance for vascular access device complications and ventilator-associated events. She is particularly interested in advances in infectious disease surveillance and tracking, using a combination of mature platforms and new electronic platforms
- Claire M. Rickard, PhD, RN, is professor of infection prevention and vascular access at the University of Queensland and Metro North Health in Brisbane, Australia. She is also adjunct professor with Griffith University and board cochair of the Australian and New Zealand Intensive Care Foundation. She established and coleads the Alliance for Vascular Access Teaching and Research (avatargroup.org.au), a large collaborative with the vision to "make vascular access complications history." Her background is in critical care and med-surg nursing followed by a focus on clinical research leading to >300 publications, including 45 randomized controlled trials. She was recognized in the International Nurse Researcher Hall of Fame in 2013, and elected to the Australian Academy of Health and Medical Sciences in 2015 and the American Academy of Nursing in 2021
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Thamke MV, Samal S, Vaidya BP. Effect of Physiotherapy on an Elderly Patient With Distal Anterior Cerebral Artery Aneurysm Clipping. Cureus 2024; 16:e57225. [PMID: 38686235 PMCID: PMC11056804 DOI: 10.7759/cureus.57225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
This case study analyzes the effectiveness of physiotherapy in the treatment of a female patient, aged 65 years, with hypertension who had a history of subdural hematoma (SDH) secondary to a distal anterior cerebral artery (DACA) aneurysm rupture. For that, she underwent DACA aneurysm clipping surgery and developed a disability on the right side of her body. The patient had diminished functional independence, weak muscles, and restricted mobility when she first arrived. A thorough physiotherapy program was developed with the goals of increasing mobility, building independence in daily living tasks, and improving motor function. Adapted to the patient's particular requirements and limits, the intervention included therapeutic exercises, gait training, balancing exercises, and functional training. Assessments were carried out on a regular basis to track improvement and modify the treatment plan as necessary. The patient's motor function, mobility, and functional independence were significantly improved during the intervention. Physiotherapy played a crucial role in significantly improving the patient's recovery, quality of life, and right-side disability following the DACA aneurysm clipping surgery. The presented case study clearly highlights the value of early and focused physiotherapy intervention in the effective management of neurological impairments and in achieving better rehabilitation outcomes in patients with similar medical presentations.
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Affiliation(s)
- Maitri V Thamke
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Snehal Samal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhumala P Vaidya
- Neurological Physical Therapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Zade AP, Bhoge SS, Seth NH, Phansopkar P. Rehabilitation of Traumatic Acute Subdural Hematoma and Subarachnoid Hemorrhage: A Case Report. Cureus 2023; 15:e50660. [PMID: 38229824 PMCID: PMC10790600 DOI: 10.7759/cureus.50660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
A head injury or cerebrovascular illness may be the cause of acute intracranial hemorrhage. Making a precise diagnosis is challenging since diagnostic imaging might be challenging in both situations. In this case report, an aneurysmal rupture related head injury resulted in an acute subdural hematoma (SHD) after the patient lost consciousness. A 54-year-old male was found in a state of unconsciousness on the ground and was brought to the nearest hospital. Computed tomography (CT) scan showed an oblique fracture involving the bilateral frontal and right parietal bones along with underlying SDH, subarachnoid hemorrhage (SAH), and hemorrhagic contusion along with midline shift. The case report highlights the rehabilitation journey of a patient with acute SDH and SAH. The patient can now sit independently and stand with minimal assistance. Vasospasm detection, prevention, and treatment need to be the norm at that time. This case demonstrates the effectiveness of a comprehensive rehabilitation approach in promoting mobility and independence for patients with traumatic brain injuries.
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Affiliation(s)
- Amisha P Zade
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shruti S Bhoge
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikita H Seth
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratik Phansopkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Souter J, Behbahani M, Sharma S, Cantrell D, Alden TD. Middle meningeal artery embolization in pediatric patient. Childs Nerv Syst 2022; 38:1861-1866. [PMID: 35962222 DOI: 10.1007/s00381-022-05639-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE There is paucity of data in management of recurrent and expanding subdural hematomas (SDH) within the pediatric population, who are otherwise not surgical candidates. Middle meningeal artery (MMA) embolization has been utilized minimally in this population and here, we explore the utility of this procedure in a 15-month-old-child, along with review of the literature. METHODS A case report of a 15-month-old child who underwent MMA embolization for recurrent and expanding SDH in the setting of anticoagulation for cardiac condition. A literature review of MMA embolization in pediatric patients was conducted. RESULTS Initially stabilization of SDH was noted on serial imaging; however, recurrent hemorrhages were noted with subsequent boluses of antiplatelet and anticoagulating agents. There are only 5 total reported cases, included ours, of MMA embolization in pediatrics with an overall success rate of 80%. CONCLUSION Treatment of chronic or recurrent subdural hematoma by MMA embolization in the pediatric population is understudied. Our case notes limitation of this procedure and impact on long-term success, specifically in patients with systemic illness and ongoing anticoagulation.
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Affiliation(s)
- John Souter
- Department of Neurological Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Mandana Behbahani
- Division of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Shelly Sharma
- Division of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Donald Cantrell
- Division of Interventional Radiology, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Tord D Alden
- Division of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, USA.
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Bartoli M, Mannes I, Aikem N, Rambaud C, de Boissieu P, Adamsbaum C. Is bridging vein rupture/thrombosis associated with subdural hematoma at birth? Pediatr Radiol 2022; 52:932-940. [PMID: 34988598 DOI: 10.1007/s00247-021-05255-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 09/20/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The combination of bridging vein rupture/thrombosis and subdural hematoma in infants has recently gained attention as highly suggestive of abusive head trauma. While subdural hematomas are frequently observed at birth, there are no previous studies of bridging vein rupture/thrombosis prevalence in that context. OBJECTIVE To evaluate the prevalence of bridging vein rupture/thrombosis in newborns with and without subdural hematoma. MATERIALS AND METHODS This bicentric retrospective study (2012-2019) looked at all brain MRIs performed in neonates. We noted delivery method, demographic data and intracranial injuries and analyzed any clots at the vertex as potential markers of bridging vein rupture/thrombosis. RESULTS We analyzed 412 MRIs in 412 neonates. Age was (mean ± standard deviation [SD]) 5.4±2.2 days and 312 (76%) infants were full term (38.3±2.9 weeks from last menstrual period). The delivery method was vaginal birth for 42% (n=174), cesarean section for 43% (n=179), and unknown for 14% (n=59). Subdural hematoma was present in 281 MRIs (68.0%, [95% confidence interval = 63.3-72.5]). Six MRIs showed at least one clot at the vertex, assumed to be possible bridging vein rupture/thrombosis (1.5%, [0.5-3.1%]). Only one MRI showed more than two clots at the vertex, in a context of maternal infection. There was no significant difference in terms of gestational age at birth, delivery method or the presence of subdural hematoma or parenchymal injuries between those 6 infants and the 406 others. CONCLUSION Bridging vein rupture/thrombosis at birth is very rare and unlikely to be related to subdural hematoma.
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Affiliation(s)
- Marion Bartoli
- Pediatric Radiology Department, AP-HP, Bicêtre Hospital, 94270, Le Kremlin Bicêtre, France
| | - Inès Mannes
- Pediatric Radiology Department, AP-HP, Bicêtre Hospital, 94270, Le Kremlin Bicêtre, France.,Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Nadia Aikem
- Radiology Department, AP-HP, A Béclère Hospital, Clamart, France
| | - Caroline Rambaud
- Forensic Unit, AP-HP, Raymond Poincaré Hospital, Garches, France
| | - Paul de Boissieu
- Epidemiology and Public Health Department, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Catherine Adamsbaum
- Pediatric Radiology Department, AP-HP, Bicêtre Hospital, 94270, Le Kremlin Bicêtre, France. .,Paris-Saclay University, Le Kremlin Bicêtre, France.
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Zahl SM, Mack JA, Rossant C, Squier W, Wester K. Thrombosis is not a marker of bridging vein rupture in infants with alleged abusive head trauma. Acta Paediatr 2021; 110:2686-2694. [PMID: 33964045 PMCID: PMC8519117 DOI: 10.1111/apa.15908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
Aim Thrombosis of bridging veins has been suggested to be a marker of bridging vein rupture, and thus AHT, in infants with subdural haematoma. Methods This is a non‐systematic review based on Pubmed search, secondary reference tracking and authors’ own article collections. Results Radiological studies asserting that imaging signs of cortical vein thrombosis were indicative of traumatic bridging vein rupture were unreliable as they lacked pathological verification of either thrombosis or rupture, and paid little regard to medical conditions other than trauma. Autopsy attempts at confirmation of ruptured bridging veins as the origin of SDH were fraught with difficulty. Moreover, microscopic anatomy demonstrated alternative non‐traumatic sources of a clot in or around bridging veins. Objective pathological observations did not support the hypothesis that a radiological finding of bridging vein thrombosis was the result of traumatic rupture by AHT. No biomechanical models have produced reliable and reproducible data to demonstrate that shaking alone can be a cause of bridging vein rupture. Conclusion There is no conclusive evidence supporting the hypothesis that diagnostic imaging showing thrombosed bridging veins in infants correlates with bridging vein rupture. Hence, there is no literature support for the use of thrombosis as a marker for AHT.
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Affiliation(s)
| | - Julie A. Mack
- Penn State Hershey Medical Center Department of Radiology Hershey PA USA
| | | | - Waney Squier
- Formerly Department of Neuropathology John Radcliffe Hospital Oxford UK
| | - Knut Wester
- Department of Clinical Medicine K1 University of Bergen Bergen Norway
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Wittschieber D, Muggenthaler H, Mall G, Mentzel HJ. [Bridging vein injuries in shaken baby syndrome : Forensic-radiological meta-analysis with special focus on the tadpole sign]. Radiologe 2021; 61:71-79. [PMID: 33289862 PMCID: PMC7810648 DOI: 10.1007/s00117-020-00780-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Shaken baby syndrome is a common variant of the abusive head trauma in infants and toddlers and is still subject of intensive research. In recent years, a number of radiological studies on the diagnostic and forensic relevance of injured bridging veins were conducted using different imaging modalities. The present article will give an overview on the current state of research in this field and will discuss the forensic implications. The meta-analysis of the seven currently existing studies revealed that injuries of the bridging veins and bridging vein thromboses, respectively, frequently appear as rounded, enlarged, and/or tubular structures. The "tadpole sign" may serve as a valuable tool for the identification of these formations. Especially, T2*/SWI (susceptibility-weighted imaging) sequences allow for good detectability of these lesions and should always be generated when abusive head trauma is suspected. In conclusion, it can be recommended that the presence of radiologically detectable bridging vein injuries should give reason to search for other manifestations of physical child abuse.
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Affiliation(s)
- D Wittschieber
- Institut für Rechtsmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - H Muggenthaler
- Institut für Rechtsmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - G Mall
- Institut für Rechtsmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - H-J Mentzel
- Institut für Diagnostische und Interventionelle Radiologie, Sektion Kinderradiologie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Deutschland
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Cortical and bridging veins of the upper cerebral convexity: a magnetic resonance imaging study. Surg Radiol Anat 2020; 43:235-242. [PMID: 32964269 DOI: 10.1007/s00276-020-02579-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE There is no study exploring the cortical veins (CVs) and connecting bridging veins (BVs) with neuroimaging modalities. The present study aimed to characterize these veins of the upper cerebral convexity. METHODS A total of 89 patients with intact cerebral hemispheres and covering meninges underwent thin-sliced, contrast magnetic resonance imaging (MRI). In addition, three injected specimens were dissected in this study. RESULTS In cadaver dissection, the BVs were observed to course in the arachnoid sheaths, suspended from the dura mater. The medial parts of the BVs, located near the superior sagittal sinus (SSS)-BV junction site, were occasionally exposed subdurally. The CVs were formed by venous channels arising from the cerebral gyri and those emerging from the sulci. On MRI, the CVs and connecting BVs were identified in the medial and latera convexity areas and medial surface of the cerebrum. These veins were highly variable in number, thickness, length, course, and distribution. In the medial convexity area, the CVs arising from the gyri were identified in 58% of patients, while they were found only in 11% of patients in the lateral convexity area. CONCLUSION In the medial convexity area, involving the parasagittal region, the CVs connect more densely with the BVs that may predispose to injury during neurosurgical procedures. Mechanical impact exerted the area, diameter of the veins in the craniocaudal direction, and number of venous afferences may affect the SSS-BV junctional region in an indirect manner and lead to the development of acute subdural hematoma.
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Orman G, Kralik SF, Meoded A, Desai N, Risen S, Huisman TAGM. MRI Findings in Pediatric Abusive Head Trauma: A Review. J Neuroimaging 2019; 30:15-27. [PMID: 31696594 DOI: 10.1111/jon.12670] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 12/20/2022] Open
Abstract
Trauma is the most common cause of death and significant morbidity in childhood; abusive head trauma (AHT) is a prominent cause of significant morbidity and mortality in children younger than 2 years old. Correctly diagnosing AHT is challenging both clinically and radiologically. The primary diagnostic challenges are that the abused children are usually too young to provide an adequate history, perpetrators are unlikely to provide truthful account of trauma, and clinicians may be biased in their assessment of potentially abused children. The main radiological challenge is that there is no single imaging finding that is independently specific for or diagnostic of AHT. The radiological evaluation should be based on the multiplicity and severity of findings and an inconsistency with the provided mechanism of trauma. While the most common neuroimaging finding in AHT is subdural hemorrhage, other less well-known magnetic resonance imaging (MRI) findings such as the "lollipop sign" or "tadpole sign," parenchymal or cortical lacerations, subpial hemorrhage, cranio-cervical junction injuries including retroclival hematomas, as well as diffuse hypoxic brain injury have been identified and described in the recent literature. While AHT is ultimately a clinical diagnosis combining history, exam, and neuroimaging, familiarity with the typical as well as the less-well known MRI findings will improve recognition of AHT by radiologists.
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Affiliation(s)
- Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital
| | - Stephen F Kralik
- Edward B. Singleton Department of Radiology, Texas Children's Hospital
| | - Avner Meoded
- Edward B. Singleton Department of Radiology, Texas Children's Hospital
| | - Nilesh Desai
- Edward B. Singleton Department of Radiology, Texas Children's Hospital
| | - Sarah Risen
- Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, TX
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Cheshire EC, Biggs MJP, Hollingbury FE, Fitzpatrick-Swallow VL, Prickett TRA, Malcomson RDG. Frequency of macroscopic intradural hemorrhage with and without subdural hemorrhage in early childhood autopsies. Forensic Sci Med Pathol 2019; 15:184-190. [PMID: 30915608 PMCID: PMC6505489 DOI: 10.1007/s12024-019-00103-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2019] [Indexed: 11/28/2022]
Abstract
Some authors have suggested that in the fetus, neonate and infant, intradural hemorrhage (IDH) is relatively common and often presents alongside subdural hemorrhage (SDH). These authors have theorized that pediatric SDH may result from an IDH due to blood leakage from a dural vascular plexus. In this study, we report the inter-observer variation for detection of IDH from a retrospectively collected series of pediatric autopsy photographs, with and without SDH. Autopsy photographs of the falx and tentorium from 27 neonatal, infant and early childhood autopsies were assessed by two independent consultant forensic pathologists blinded to all case histories for the presence and extent (focal or diffuse) of IDH. Inter-observer agreement between the pathologists was calculated using Cohen’s kappa coefficient. The occurrence of subdural hemorrhage was also recorded at autopsy. A kappa coefficient value of 0.669 (p = 0.001), indicated a substantial level of agreement for the presence/absence of IDH between the pathologists. For the extent of IDH a kappa coefficient value of 0.6 (p = 0.038) indicated a moderate level of agreement. The pathologists agreed on the presence of IDH in 10 of the 27 cases. Subdural hemorrhage was recorded for 8 out of 27 cases. Of these 8 cases, it was agreed that 4 had IDH. Using standardized methods of image capture and assessment, inter-observer agreement for the presence/absence of IDH was substantial. In this paper, we report a much lower frequency of macroscopic IDH occurring alongside SDH than previous studies, which included both gross observation of IDH and histological examination.
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Affiliation(s)
- Emma C Cheshire
- East Midlands Forensic Pathology Unit, University of Leicester, Robert Kilpatrick Building, Level 3 Leicester Royal Infirmary, Leicester, LE2 7LX, UK.
| | - Mike J P Biggs
- East Midlands Forensic Pathology Unit, University of Leicester, Robert Kilpatrick Building, Level 3 Leicester Royal Infirmary, Leicester, LE2 7LX, UK
| | - Frances E Hollingbury
- East Midlands Forensic Pathology Unit, University of Leicester, Robert Kilpatrick Building, Level 3 Leicester Royal Infirmary, Leicester, LE2 7LX, UK
| | - Virginia L Fitzpatrick-Swallow
- East Midlands Forensic Pathology Unit, University of Leicester, Robert Kilpatrick Building, Level 3 Leicester Royal Infirmary, Leicester, LE2 7LX, UK
| | - Thomas R A Prickett
- Histopathology Department, Leicester Royal Infirmary, Infirmary Close, Leicester, LE1 5WW, UK
| | - Roger D G Malcomson
- Histopathology Department, Leicester Royal Infirmary, Infirmary Close, Leicester, LE1 5WW, UK
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11
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Wittschieber D, Karger B, Pfeiffer H, Hahnemann ML. Understanding Subdural Collections in Pediatric Abusive Head Trauma. AJNR Am J Neuroradiol 2018; 40:388-395. [PMID: 30523144 DOI: 10.3174/ajnr.a5855] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/16/2018] [Indexed: 11/07/2022]
Abstract
Life-threatening physical abuse of infants and toddlers is frequently correlated with head injuries. A common variant of the abusive head trauma is the shaken baby syndrome. The present review article sheds light on subdural collections in children with abusive head trauma and aims at providing a recent knowledge base for various medical disciplines involved in diagnostic procedures and legal proceedings. To this end, the different subdural collection entities are presented and illustrated. The pathophysiologic background is explained. Differential and age-diagnostic aspects are discussed and summarized by tabular and graphic overviews. Two problematic constellations frequently occurring during initial CT investigations are evaluated: A mixed-density subdural collection does not prove repeated trauma, and hypodense subdural collections are not synonymous with chronicity. The neuroradiologic analysis and assessment of subdural collections may decisively contribute to answering differential diagnostic and forensic questions. In addition to more reference data, a harmonization of terminology and methodology is urgently needed, especially with respect to age-diagnostic aspects.
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Affiliation(s)
- D Wittschieber
- From the Institute of Legal Medicine (D.W., B.K., H.P.), University Hospital Münster, Münster, Germany .,Institute of Legal Medicine (D.W.), Friedrich Schiller University Jena, Jena, Germany
| | - B Karger
- From the Institute of Legal Medicine (D.W., B.K., H.P.), University Hospital Münster, Münster, Germany
| | - H Pfeiffer
- From the Institute of Legal Medicine (D.W., B.K., H.P.), University Hospital Münster, Münster, Germany
| | - M L Hahnemann
- Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.L.H.), University Hospital Essen, Essen, Germany.,Department of Neuroradiological Diagnostics and Intervention (M.L.H.), Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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