Traumatic injury to the posterior fossa: a secondary analysis and description of case series from the NEXUS head injury datasetResearch in context

Richelle J. Cooper; Thomas E. Akie; Tarika Gujral; Shivam Rana; Kyle Bui; Ryan Factora; Alexandra Quinones; Malkeet Gupta; Gregory W. Hendey; Robert M. Rodriguez; William R. Mower

The Lancet Regional Health. Americas (Jun 2024)

Traumatic injury to the posterior fossa: a secondary analysis and description of case series from the NEXUS head injury datasetResearch in context

Richelle J. Cooper,
Thomas E. Akie,
Tarika Gujral,
Shivam Rana,
Kyle Bui,
Ryan Factora,
Alexandra Quinones,
Malkeet Gupta,
Gregory W. Hendey,
Robert M. Rodriguez,
William R. Mower

Affiliations

Richelle J. Cooper: Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Thomas E. Akie: Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, USA
Tarika Gujral: Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Shivam Rana: Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Kyle Bui: Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Ryan Factora: Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Alexandra Quinones: Department of Emergency Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
Malkeet Gupta: Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Antelope Valley Hospital, Lancaster, CA, USA
Gregory W. Hendey: Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCSF-Fresno, Medical Education Program, Fresno, CA, USA
Robert M. Rodriguez: Department of Emergency Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
William R. Mower: Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Corresponding author. Emeritus Professor of Emergency Medicine, David Geffen UCLA School of Medicine, UCLA Department of Emergency Medicine, 1100 Glendon Ave, Suite 1200, Los Angeles, CA, 90024, USA.

Journal volume & issue: Vol. 34
p. 100760

Abstract

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Summary: Background: Traumatic brain injuries involving the posterior fossa are rare and case reports indicate they often result in severe outcomes. We seek to describe characteristics and outcomes of traumatic posterior fossa injuries. Methods: We performed a planned secondary analysis of all patients with posterior fossa injuries enrolled in the NEXUS head computed tomography (CT) validation study dataset. The dataset includes prospectively collected data on all patients undergoing non-contrast cranial CT following blunt traumatic head injury from April 2006 to December 2015, at four emergency departments comprising community and university sites, as well as urban, suburban and rural settings in California (Antelope Valley Hospital, San Francisco General Hospital, UCLA Ronald Reagan Medical Center, UCSF Fresno Community Regional Medical Center). We classified each patient into one of three injury patterns: Type I—notable traumatic injuries primarily above the tentorium, with minimal posterior fossa involvement; Type II—notable traumatic injuries both above and within the posterior fossa; and Type III—notable traumatic injuries primarily within the posterior fossa. We extracted demographic data for each patient as well as physician assessments of the NEXUS head CT and Canadian Head CT rule clinical criteria, mechanisms of injury, patient outcomes, and the location and types of intracranial injuries sustained. Findings: Of 11,770 patients in the database, 184 (1.6%) had posterior fossa injuries on CT imaging. Mean age was 55.4 years (standard deviation 22.5 years, range 2–96 years); 131 (71.2%) were males. We identified 63 patients with Type I injuries, 87 with Type II injuries, and 34 Type III injuries. The most common mechanisms of injury were falls (41%), pedestrian vs automobile (15%), and motor vehicle collisions (13%). On presentation most patients had altered mental status (72%), abnormal behavior (53%), or a neurologic deficit (55%). The majority of individuals, 151 (82%), had clinically important injuries and 111 (60%) required neurosurgical intervention. The dispositions for the subjects included 52 deaths (28%), 49 (27%) patients discharged home, and 48 (26%) discharged to rehabilitation facilities. When compared to individuals with Type I and Type II injuries, patients with Type III injuries had lower mortality (6% vs 30% and 35%) and higher percentage of patients discharged home (60% vs 19% and 21%). Interpretation: Patients with Type I and II injury patterns (those that involve both the posterior fossa and supratentorium) experienced high mortality and disability. Patients with Type III injuries (isolated posterior fossa) had a better prognosis. Funding: None.

Published in The Lancet Regional Health. Americas

ISSN: 2667-193X (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.thelancet.com/journals/lanam/home

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