Top

Published in:

01-01-2020 | Central Nervous System Trauma | Original Article

Updating the risk profile of fatal head trauma: an autopsy study with focus on age- and sex-dependent differences

Authors: Katharina Kronsbein, Bernd Karger, Jan Budczies, Heidi Pfeiffer, Daniel Wittschieber

Published in: International Journal of Legal Medicine | Issue 1/2020

Abstract

Fatal head trauma (FHT) represents one of the most frequent causes of death diagnosed in forensic pathology. However, profound statistic autopsy data on FHT is still sparse. Therefore, the purpose of this study was to investigate the circumstances and injury patterns of FHT with particular focus on age and sex, and additionally, to describe a recent risk profile of FHT. To this end, the forensic autopsy records of each FHT case at a large German university hospital during a 10-year period (2006–2015) were analyzed retrospectively (n = 372). The male-female ratio was 2.6:1. Regarding median age, females were 12.5 years older than males. Traffic-associated FHT represents the major mechanism of death, followed by fall-associated FHT. While accident was the major manner of death and presented a similar distribution of age and sex, homicides were the only subgroup with a significantly lower ratio between males and females. Skull fractures occurred in 78.2% and intracranial hemorrhages in 80.6% of all cases. In summary and partly in contrast to clinical data on head trauma, FHT still occurs predominantly in male individuals under the age of 45 years, in the context of traffic accidents and affected by alcohol intake. Improvements in traffic security as well as continuing surveillance of the incidence of FHT by forensic autopsies are necessary to further reduce the incidence of FHT.

Gesundheitsberichterstattung des Bundes 2019 (Sterbefälle, Sterbeziffern je 100.000 Einwohner, altersstandardisiert, ab 1998) Gliederungsmerkmale: Jahre, Region, Alter, Geschlecht, Nationalität, ICD-10, Art der Standardisierung. http://www.gbe-bund.de/oowa921-install/servlet/oowa/aw92/WS0100/_XWD_FORMPROC?TARGET=&PAGE=_XWD_238&OPINDEX=5&HANDLER=_XWD_CUBE.SETPGS&DATACUBE=_XWD_266&D.000=3728&D.001=1000001&D.002=1000002&D.003=1000004&D.004=1000006&D.011=44302. Accessed 11 September 2019

Taylor CA, Bell JM, Breiding MJ, Xu L (2017) Traumatic brain injury–related emergency department visits, hospitalizations, and deaths - United States, 2007 and 2013. MMWR Surveill Summ 66:1–16. https://doi.org/10.15585/mmwr.ss6609a1 CrossRefPubMedPubMedCentral

Evans JA, van Wessem KJP, McDougall D, Lee KA, Lyons T, Balogh ZJ (2010) Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg 34:158–163. https://doi.org/10.1007/s00268-009-0266-1 CrossRefPubMed

Probst C, Zelle BA, Sittaro NA, Lohse R, Krettek C, Pape HC (2009) Late death after multiple severe trauma: when does it occur and what are the causes? J Trauma 66:1212–1217. https://doi.org/10.1097/TA.0b013e318197b97c CrossRefPubMed

Faul M, Xu L, Wald MM, Coronado VG (2010) Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths 2002–2006. Centers for Disease Control and Prevention. National Center for Injury Prevention and Control, Atlanta https://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf. Accessed 16 September 2019CrossRef

Nguyen R, Fiest KM, McChesney J, Kwon C, Jette N, Frolkis AD, Atta C, Mah S, Dhaliwal H, Reid A, Pringsheim T, Dykeman J, Gallagher C (2016) The international incidence of traumatic brain injury: a systematic review and meta-analysis. Can J Neurol Sci 43:774–785. https://doi.org/10.1017/cjn.2016.290 CrossRefPubMed

Ondruschka B, Schuch S, Pohlers D, Franke H, Dreßler J (2018) Acute phase response after fatal traumatic brain injury. Int J Legal Med 132(2):531–539. https://doi.org/10.1007/s00414-017-1768-2 CrossRefPubMed

Ondruschka B, Sieber M, Kirsten H, Franke H, Dreßler J (2018) Measurement of cerebral biomarkers proving traumatic brain injuries in post-mortem body fluids. J Neurotrauma 35(17):2044–2055. https://doi.org/10.1089/neu.2017.5441 CrossRefPubMed

Neri M, Frati A, Turillazzi E, Cantatore S, Cipolloni L, Di Paolo M, Frati P, La Russa R, Maiese A, Scopetti M, Santurro A, Sessa F, Zamparese R, Fineschi V (2018) Immunohistochemical evaluation of Aquaporin-4 and its correlation with CD68, IBA-1, HIF-1α, GFAP, and CD15 expressions in fatal traumatic brain Injury. Int J Mol Sci 19(11):3544. https://doi.org/10.3390/ijms19113544 CrossRefPubMedCentral

10.

Oerter S, Förster C, Bohnert M (2019) Validation of sodium/glucose cotransporter proteins in human brain as a potential marker for temporal narrowing of the trauma formation. Int J Legal Med 133(4):1107–1114. https://doi.org/10.1007/s00414-018-1893-6 CrossRefPubMed

11.

Pinchi E, Frati A, Cipolloni L, Aromatario M, Gatto V, La Russa R, Pesce A, Santurro A, Fraschetti F, Frati P, Fineschi (2018) Clinical-pathological study on β-APP, IL-1β, GFAP, NFL, Spectrin II, 8OHdG, TUNEL, miR-21, miR-16, miR-92 expressions to verify DAI-diagnosis, grade and prognosis. Sci Rep 8(1):2387. https://doi.org/10.1038/s41598-018-20699-1

12.

Olczak M, Niderla-Bielińska J, Kwiatkowska M, Samojłowicz D, Tarka S, Wierzba-Bobrowicz T (2017) Tau protein (MAPT) as a possible biochemical marker of traumatic brain injury in postmortem examination. Forensic Sci Int 280:1–7. https://doi.org/10.1016/j.forsciint.2017.09.008 CrossRefPubMed

13.

Schober K, Ondruschka B, Dreßler J, Abend M (2015) Detection of hypoxia markers in the cerebellum after a traumatic frontal cortex injury: a human postmortem gene expression analysis. Int J Legal Med 129(4):701–707. https://doi.org/10.1007/s00414-014-1129-3 CrossRefPubMed

14.

Peeters W, van den Brande R, Polinder S, Brazinova A, Steyerberg EW, Lingsma HF, Maas AIR (2015) Epidemiology of traumatic brain injury in Europe. Acta Neurochir 157:1683–1696. https://doi.org/10.1007/s00701-015-2512-7 CrossRefPubMed

15.

Leo P, McCrea M (2016) Epidemiology. In: Laskowitz D, Grant G (eds) Translational research in traumatic brain Injury. CRC Press/Taylor and Francis Group, Boca Raton

16.

Steudel WI, Cortbus F, Schwerdtfeger K (2005) Epidemiology and prevention of fatal head injuries in Germany - trends and the impact of reunification. Acta Neurochir 147:231–242. https://doi.org/10.1007/s00701-004-0441-y CrossRefPubMed

17.

Lyle DM, Quine S, Bauman A, Pierce JP (1990) Counting heads: estimation traumatic brain injury in New South Wales. Community Health Stud 14(2):118–125CrossRefPubMed

18.

Firsching R, Rickels E, Mauer UM, Sakowitz OW, Messing-Jünger M, Engelhard K, Schwenkreis P, Linn J, Biberthaler P, Schwerdtfeger K (2015) AWMF-S2e-Leitlinie Schädel-Hirn-Trauma im Erwachsenenalter. https://www.awmf.org/uploads/tx_szleitlinien/008-001l_S2e_Schaedelhirntrauma_SHT_Erwachsene_2016-06.pdf. Accessed 11 September 2019

19.

Menon DK, Schwab K, Wright DW, Maas AI; Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health (2010) Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil 91(11):1637–1640. https://doi.org/10.1016/j.apmr.2010.05.017 CrossRef

20.

Florou C, Zorilă AL, Zorilă MV, Marinescu MA, Andrei CM, Păvăloiu RM, Mogoantă L, Zăvoi RE (2016) Clinico-statistical and morphological aspects of severe traumatic brain injuries. Romanian J Morphol Embryol 57(2):391–400

21.

Bjarkø VV, Skandsen T, Moen KG, Gulati S, Helseth E, Nilsen TIL, Vik A (2019) Time of injury and relation to alcohol intoxication in moderate-to-severe traumatic brain injury: a decade-long prospective study. World Neurosurg 122:e684–e689. https://doi.org/10.1016/j.wneu.2018.10.122 CrossRefPubMed

22.

El-Menyar A, Consunji R, Asim M, Mekkodathil A, Latifi R, Smith G, Parchani A, Al-Thani H (2019) Traumatic brain injury in patients screened for blood alcohol concentration based on the mechanism of injury. Brain Inj 33(4):419–426. https://doi.org/10.1080/02699052.2018.1553065 CrossRefPubMed

23.

Rickels E, von Wild K, Wenzlaff P (2010) Head injury in Germany: a population-based prospective study on epidemiology, causes, treatment and outcome of all degrees of head-injury severity in two distinct areas. Brain Inj 24(12):1491–1504. https://doi.org/10.3109/02699052.2010.498006 CrossRefPubMed

24.

Ferguson SA, Mouzon BC, Lynch C, Lungmus C, Morin A, Crynen G, Carper B, Bieler G, Mufson EJ, Stewart W, Mullan M, Crawford F (2017) Negative impact of female sex on outcomes from repetitive mild traumatic brain injury in hTau mice is age dependent: a chronic effects of neurotrauma consortium study. Front Aging Neurosci 9:416. https://doi.org/10.3389/fnagi.2017.00416 CrossRefPubMedPubMedCentral

25.

Armstead WM, Riley J, Vavilala MS (2017) Sex and age differences in epinephrine mechanisms and outcomes after brain injury. J Neurotrauma 34(8):1666–1675. https://doi.org/10.1089/neu.2016.4770 CrossRefPubMedPubMedCentral

26.

Russell AL, Handa RJ, Wu TJ (2018) Sex-dependent effects of mild blast-induced traumatic brain injury on corticotropin-releasing factor receptor gene expression: potential link to anxiety-like behaviors. Neuroscience 392:1–12. https://doi.org/10.1016/j.neuroscience.2018.09.014 CrossRefPubMed

27.

Semple BD, Dixit S, Shultz SR, Boon WC, O’Brien TJ (2017) Sex-dependent changes in neuronal morphology and psychosocial behaviors after pediatric brain injury. Behav Brain Res 319:48–62. https://doi.org/10.1016/j.bbr.2016.10.045 CrossRefPubMed

28.

Wittschieber D, Klauschen F, Kimmritz AC, von Winterfeld M, Kamphues C, Scholman HJ, Erbersdobler A, Pfeiffer H, Denkert C, Dietel M, Weichert W, Budczies J, Stenzinger A (2012) Who is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin. PLoS One 7(5):e37460. https://doi.org/10.1371/journal.pone.0037460 CrossRefPubMedPubMedCentral

29.

Bratzke H, Weber A (2011) Epidemiology of fatal brain injury from a forensic perspective [Article in German]. Rechtsmedizin 21:258–264. https://doi.org/10.1007/s00194-011-0760-2 CrossRef

30.

Akang EE, Kuti MA, Osunkoya AO, Komolafe EO, Malomo AO, Shokunbi MT, Amutta SB (2002) Pattern of fatal head injuries in Ibadan - a 10 year review. Med Sci Law 42(2):160–166. https://doi.org/10.1177/002580240204200207 CrossRefPubMed

31.

Maegele M, Lefering R, Sakowitz O, Kopp MA, Schwab JM, Steudel WI, Unterberg A, Hoffmann R, Uhl E, Marzi I (2019) The incidence and management of moderate to severe head injury. Dtsch Arztebl Int 116(10):167–173. https://doi.org/10.3238/arztebl.2019.0167 CrossRefPubMedPubMedCentral

32.

Faul M, Coronado V (2015) Epidemiology of traumatic brain injury. In: Grafman J, Salazar AM (eds) Handbook of Clinical Neurology Vol 127 (3^rd series) Traumatic Brain Injury, Part I. Elsevier, pp 3–13. https://doi.org/10.1016/B978-0-444-52892-6.00001-5

33.

Mauritz W, Brazinova A, Majdan M, Rehorcikova V, Leitgeb J (2014) Deaths due to traumatic brain injury in Austria between 1980 and 2012. Brain Inj 28(8):1096–1101. https://doi.org/10.3109/02699052.2014.904522 CrossRefPubMed

34.

Statistisches Bundesamt (Destatis) (2018) Bevölkerung, Familien, Lebensformen. In: Statistisches Bundesamt (Destatis) Statistisches Jahrbuch, vol 2018, pp 23–84

35.

Brewer JW, Cox CS, Fletcher SA, Shah MN, Sandberg M, Sandberg DI (2019) Analysis of pediatric gunshot wounds in Houston, Texas: a social perspective. J Pediatr Surg 54(4):783–791. https://doi.org/10.1016/j.jpedsurg.2018.10.061 CrossRefPubMed

36.

Global Burden of Disease 2016 Injury Collaborators, Naghavi M, Marczak LB, Kutz M, et al. (2018) Global mortality from firearms, 1990-2016. JAMA 320(8):792–814. https://doi.org/10.1001/jama.2018.10060 CrossRef

37.

Choudhary AK, Servaes S, Slovis TL, Palusci VJ, Hedlund GL, Narang SK, Moreno JA, Dias MS, Christian CW, Nelson MD Jr, Silvera VM, Palasis S, Raissaki M, Rossi A, Offiah AC (2018) Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 48(8):1048–1065. https://doi.org/10.1007/s00247-018-4149-1 CrossRefPubMed

38.

Hahnemann ML, Kinner S, Schweiger B, Bajanowski T, Karger B, Pfeiffer H, Wittschieber D (2015) Imaging of bridging vein thrombosis in infants with abusive head trauma: the “Tadpole Sign”. Eur Radiol 25(2):299–305. https://doi.org/10.1007/s00330-014-3443-z CrossRefPubMed

39.

Wittschieber D, Kinner S, Pfeiffer H, Karger B, Hahnemann ML (2018) Forensic aspects of imaging procedures in shaken baby syndrome. Methodology, findings, differential diagnoses [Article in German]. Rechtsmedizin 28(6):486–494. https://doi.org/10.1007/s00194-018-0274-2 CrossRef

40.

Wittschieber D, Karger B, Pfeiffer H, Hahnemann ML (2019) Understanding subdural collections in pediatric abusive head trauma. AJNR Am J Neuroradiol 40(3):388–395. https://doi.org/10.3174/ajnr.A5855 CrossRefPubMedPubMedCentral

41.

Gesundheitsberichterstattung des Bundes (2019 Sterbefälle, Sterbeziffern je 100.000 Einwohner, altersstandardisiert, ab 1998). Gliederungsmerkmale: Jahre, Region, Alter, Geschlecht, Nationalität, ICD-10, Art der Standardisierung. http://www.gbe-bund.de/oowa921-install/servlet/oowa/aw92/dboowasys921.xwdevkit/xwd_init?gbe.isgbetol/xs_start_neu/&p_aid=i&p_aid=11324579&nummer=6&p_sprache=D&p_indsp=96&p_aid=38918937. Accessed 11 September 2019

42.

Tsirigotis K, Gruszczynski W, Tsirigotis M (2011) Gender differentiation in methods of suicide attempts. Med Sci Monit 17(8):PH65–PH70. https://doi.org/10.12659/msm.88188 CrossRefPubMedPubMedCentral

43.

Osuna E, Pérez-Cárceles MD, Conejero J, Abenza JM, Luna A (1997) Epidemiology of suicide in elderly people in Madrid, Spain (1990-1994). Forensic Sci Int 87(1):73–80CrossRefPubMed

44.

Aghakhani K, Heidari M, Yousefinejad V, Okazi A (2014) Frequency of intracranial injury in cadavers with head trauma with and without scalp injury in Tehran. J Forensic Legal Med 28:36–38. https://doi.org/10.1016/j.jflm.2014.09.009 CrossRef

45.

Menon A, Pai VK, Rajeev A (2008) Pattern of fatal head injuries due to vehicular accidents in Mangalore. J Forensic Legal Med 15(2):75–77. https://doi.org/10.1016/j.jflm.2007.06.001 CrossRef

46.

Kraus JF, Morgenstern H, Fife D, Conroy C, Nourhaj P (1989) Blood alcohol tests, prevalence of involvement, and outcomes following brain injury. Am J Public Health 79(3):294–299. https://doi.org/10.2105/AJPH.79.3.294 CrossRefPubMedPubMedCentral

47.

Peschel O, Szeimies U, Vollmar C, Kirchhoff S (2013) Postmortem 3-D reconstruction of skull gunshot injuries. Forensic Sci Int 233:45–50. https://doi.org/10.1016/j.forsciint.2013.08.012 CrossRefPubMed

48.

Panzer S, Covaliov L, Augat P, Peschel O (2017) Traumatic brain injury: Comparison between autopsy and ante-mortem CT. J Forensic Legal Med 52:62–69. https://doi.org/10.1016/j.jflm.2017.08.007 CrossRef

49.

Wittschieber D, Beck L, Vieth V, Hahnemann ML (2016) The role of 3DCT for the evaluation of chop injuries in clinical forensic medicine. Forensic Sci Int 266:e59–e63. https://doi.org/10.1016/j.forsciint.2016.05.025 CrossRefPubMed

Title: Updating the risk profile of fatal head trauma: an autopsy study with focus on age- and sex-dependent differences
Authors: Katharina Kronsbein
Bernd Karger
Jan Budczies
Heidi Pfeiffer
Daniel Wittschieber
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Central Nervous System Trauma
Suicide
Suicide
Autopsy
Epidural Hematoma
Skull Fracture
Published in: International Journal of Legal Medicine / Issue 1/2020
Print ISSN: 0937-9827
Electronic ISSN: 1437-1596
DOI: https://doi.org/10.1007/s00414-019-02187-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Updating the risk profile of fatal head trauma: an autopsy study with focus on age- and sex-dependent differences

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2020

Comparing third molar root development staging in panoramic radiography, extracted teeth, and cone beam computed tomography

Genetic polymorphisms and mutation rates of 16 X-STRs in a Han Chinese population of Beijing and application examples in second-degree kinship cases

Postmortem imaging findings and cause of death determination compared with autopsy: a systematic review of diagnostic test accuracy and meta-analysis

Arrow entrance wounds with blackened margins simulating bullet wipe

Mitochondrial DNA variation in sudden cardiac death: a population-based study

Pathological changes induced by phosphine poisoning: a study on 8 children