Infant skull fracture risk for low height falls.
Accidental falls
Anthropomorphic surrogate
Finite element modeling
Head impact
Injury risk curve
Pediatric traumatic brain injury
Journal
International journal of legal medicine
ISSN: 1437-1596
Titre abrégé: Int J Legal Med
Pays: Germany
ID NLM: 9101456
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
21
03
2018
accepted:
16
08
2018
pubmed:
9
9
2018
medline:
30
5
2019
entrez:
9
9
2018
Statut:
ppublish
Résumé
Skull fractures are common injuries in young children, typically caused by accidental falls and child abuse. The paucity of detailed biomechanical data from real-world trauma in children has hampered development of biomechanical thresholds for skull fracture in infants. The objectives of this study were to identify biomechanical metrics to predict skull fracture, determine threshold values associated with fracture, and develop skull fracture risk curves for low-height falls in infants. To achieve these objectives, we utilized an integrated approach consisting of case evaluation, anthropomorphic reconstruction, and finite element simulation. Four biomechanical candidates for predicting skull fracture were identified (first principal stress, first principal strain, shear stress, and von Mises stress) and evaluated against well-witnessed falls in infants (0-6 months). Among the predictor candidates, first principal stress and strain correlated best with the occurrence of parietal skull fracture. The principal stress and strain thresholds associated with 50 and 95% probability of parietal skull fracture were 25.229 and 36.015 MPa and 0.0464 and 0.0699, respectively. Risk curves using these predictors determined that infant falls from 0.3 m had a low probability (0-54%) to result in parietal skull fracture, particularly with carpet impact (0-1%). Head-first falls from 0.9 m had a high probability of fracture (86-100%) for concrete impact and a moderate probability (34-81%) for carpet impact. Probabilities of fracture in 0.6 m falls were dependent on impact surface. Occipital impacts from 0.9 m onto the concrete also had the potential (27-90% probability) to generate parietal skull fracture. These data represent a multi-faceted biomechanical assessment of infant skull fracture risk and can assist in the differential diagnosis for head trauma in children.
Identifiants
pubmed: 30194647
doi: 10.1007/s00414-018-1918-1
pii: 10.1007/s00414-018-1918-1
pmc: PMC6469693
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
847-862Subventions
Organisme : Centers for Disease Control and Prevention
ID : NCIPC R49CE000411
Organisme : National Institutes of Health
ID : NINDS R01NS039679
Organisme : National Institute of Neurological Disorders and Stroke
ID : NS097549
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