Lethal head trauma caused by falling objects

洋一 柳川

Lethal head trauma caused by falling objects

洋一柳川

2014, Acute Medicine & Surgery

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This report presents a case of lethal head trauma resulting from falling heavy steel materials at a metalworking factory. A 35-year-old male patient suffered an open skull defect fracture and other severe injuries leading to his death shortly after hospital admission despite emergency interventions. The paper discusses the rarity of such injuries in comparison to other causes of head trauma, highlights discrepancies in safety measures between Japan and Qatar, and stresses the importance of implementing safety protocols like helmet use and safety nets in high-risk environments to prevent similar fatalities.

Acute Medicine & Surgery 2014; 1: 188–189 doi: 10.1002/ams2.32 Letter to the Editor Lethal head trauma caused by falling objects Dear Editor, We herein report a rare case of fatal head trauma induced by falling objects. A 35-year-old male employee of a metalworking factory was engaged in lifting and carrying heavy steel materials using a machine without wearing a helmet. The steel materials fell and struck the patient in the head and face. When the rescue service arrived, the patient was found to be in a deep coma, with a weak radial pulse, labored breathing, and an open skull defect fracture associated with exposure of the frontal lobe. The patient was transported to our hospital by air ambulance. On arrival, he remained in a coma with a Glasgow Coma Scale score of 3, dilated pupils without light reflexes, and labored breathing. The findings of a physical examination carried out on admission included severe shock without a radial pulse and sinus tachycardia with a heart rate of 160 b.p.m. Following cricothyroidotomy and aggressive fluid resuscitation, computed tomography of the head revealed an open skull defect fracture, contusion of the bilateral frontal lobes, traumatic subarachnoid hemorrhage, and the disappearance of the basilar cistern with intraventricular hemorrhage, suggesting brain herniation (Fig. 1). A computed tomography scan of the chest also showed ground glass opacity, which was considered to indicate neurogenic pulmonary edema. The patient died shortly thereafter, despite supportive therapy. Head trauma is primarily caused by traffic accidents and falls.1 Head injuries caused by falling or flying objects induced by a typhoon, tornado, or earthquake have been rarely reported.2–4 Atique et al. prospectively studied all admissions regarding patients injured by falling objects in Qatar from 2008 to 2010. There were 185 patients, the mean age was 29 years, and 97% were men. All injuries occurred at construction sites and only 32 patients (17.3%) were using safety devices. Of the total number of patients, 67 had head injury (solitary, 23; multiple injuries, 44) and 22 patients required craniotomy. All of the 16 mortality cases were reported with multiple injuries. This report did not describe whether or not head injury was the main cause of death. The difference in the incidence of head injury due to falling objects between Japan and Qatar may therefore be associated with the fact that Japan has strict laws that require the wearing of a helmet and the use of safety nets at all work sites where a risk of falling objects exists. In contrast, in Qatar, only 17% of the reported cases of injury due to falling objects were described as including the use of safety devices.5 However, the Japan Construction Occupational Safety and Health Association reported 29 fatalities in 2012 due to falling objects at construction sites; therefore, such 188 Fig. 1. Computed tomography of the head of a 35-year-old male who suffered head trauma from falling steel materials. The scan reveals an open skull defect fracture, contusion of the bilateral frontal lobes, traumatic subarachnoid hemorrhage, and the disappearance of the basilar cistern with intraventricular hemorrhage, suggesting brain herniation. fatal cases due to falling objects might just not be reported medically in Japan. In order to avoid head injury due to falling objects, establishing safety nets and/or the wearing of a helmet is therefore considered to be necessary in environments in which there is a high risk of falling objects, in addition to effectively carrying out safety measures to prevent objects from falling. Tetsuya Okuhara,1 Youichi Yanagawa,2 Kazuhiko Omori, Hiromichi Ohsaka,2 Shunsuke Matsui,3 Kouji Fujiwara,3 Hiroshi Ito,1 and Souichiro Kitamura3 1 Departments of Emergency and 3Neurosurgery, Numazu City Hospital, Numazu; and 2Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni, Shizuoka, Japan 2 CONFLICT OF INTEREST N ONE. © 2014 Japanese Association for Acute Medicine Acute Medicine & Surgery 2014; 1: 188–189 REFERENCES 1 Nakamura N, Yamaura A, Shigemori M et al. Final report of the Japan Neurotrauma Data Bank project 1998–2001: 1002 cases of traumatic brain injury. Neurol. Med. Chir. (Tokyo) 2006; 46: 567–74. 2 Karibe H, Kameyama M, Kawase M, Hirano T, Kawaguchi T, Ito A. Traumatic head injury after the East-Japan earthquake. J. Jpn. Cong. Neur. Emerg. 2012; 24: 12–6. 189 3 Rotheray KR, Aitken P, Goggins WB, Rainer TH, Graham CA. Epidemiology of injuries due to tropical cyclones in Hong Kong: a retrospective observational study. Injury 2012; 43: 2055–9. 4 Eidson M, Lybarger JA, Parsons JE, MacCormack JN, Freeman JI. Risk factors for tornado injuries. Int. J. Epidemiol. 1990; 19: 1051–6. 5 Atique S, Zarour A, Siddiqui T et al. Trauma caused by falling objects at construction sites. J. Trauma Acute Care Surg. 2012; 73: 704–8. © 2014 Japanese Association for Acute Medicine

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