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A Generic Brain Trauma Computer Framework to Assess Brain Injury Severity and Bridging Vein Rupture in Traumatic Falls

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A Generic Brain Trauma Computer Framework to Assess Brain Injury Severity and Bridging Vein Rupture in Traumatic Falls Journal of Head Neck & Spine Surgery ISSN: 2577-2864 Research Article J Head Neck Spine Surg Volume 4 Issue 4 - May 2021 Copyright © All rights are reserved by C Bastien DOI: 10.19080/JHNSS.2021.04.555641 A Generic Brain Trauma Computer Framework to Assess Brain Injury Severity and Bridging Vein Rupture in Traumatic Falls C Bastien1*, C Neal Sturgess2, H Davies1, J Hardwicke3, T Cloake3 and P Zioupos4 1Institute for Future Transport and Cities, Coventry University, UK 2Department of Mechanical Engineering, University of Birmingham, UK 3University Hospitals Coventry and Warwickshire NHS Trust (UHCW), UK 4Musculoskeletal and Medicolegal Research Group, Cranfield University, UK Submission: May 04, 2021; Published: May 26, 2021 *Corresponding author: C Bastien, Institute for Future Transport and Cities, Transport Safety and Simulation Group, Coventry University, UK Abstract Traumatic Brain Injuries (TBI) have been a major cause of morbidity and mortality for many years. The Organ Trauma Model (OTM) is a severity level based on Peak Virtual Power (PVP), founded on the 2nd law of thermodynamics. The OTM model has however assumed, based onstate previous of the art literature, computer that model, bridging available veins to rupture scientific when community, the grey which matter can maximum calculate principal the threat strain to the exceeds life via white25.5%. and This grey assumption matter brain does injury not strainpermit to to rupture locate the of 15%. vein tearThis asbridging well as vein quantify model the was blood then loss, tested which in the defines case ofthe a fallinjury and severity. correctly A predicted10-pair bridging the location vein shellof tear, computer as well as model how manywas devised, veins were using damaged, published suggesting material properties that it is possible, and geometrical with more data validation connecting cases, the to grey link matter the number to the dura,of damaged and defined veins a to maximum the AIS level. principal This bridging vein model is a novel concept model which is showing a plausible response in direct linear impact and could be a good candidate for EuroNCAP pedestrian head strike against the vehicle, as well as helmet safety performance assessment. It has however not yet been validated in angular acceleration motions, hence more testing will be required in due course. Keywords: Peak virtual power; Bridging veins; THUMS; Organ trauma model; Traumatic brain injuries Abbreviations: TBI: Traumatic Brain Injuries; OTM: Organ Trauma Model; PVP: Peak Virtual Power; HIC: Head Injury Criteria; HPC: Head Injury Prediction Criterion; MPS: Maximum Principal Strain; AIS: Abbreviated Injury Scale; SDH: Subdural Hematoma; SPH: Smooth Particle Hydrodynamic Introduction Traumatic Brain Injuries (TBI) have been a major cause of the world disease burden ranking [4]. morbidity and mortality for many years, and a major systematic traffic crash-related injuries will increase from ninth to third in review was conducted in 2005 [1], which is still one of the best Another review by Post et al. [5] gives a highly detailed collected references on the subject. In Southern Europe, road account of the history of assessing TBI evolving from the Wayne State Curve in the early 50’s, through the Gadd Index leading to related to alcohol consumption are the leading cause of trauma in the Head Injury Criteria (HIC) in the US [6] and the Head Injury traffic crashes constitute the vast majority of cases, while falls Northern Europe [2]. Head trauma accounts for most deaths seen Prediction Criterion (HPC) in Europe [7]. There are several in trauma centres [3] with some researchers predicting that road papers on TBI which mention falls, however, there are few that J Head Neck Spine Surg J 4(4): JHNSS.MS.ID.555641 (2021) 0047 Journal of Head Neck & Spine Surgery analyse head injury and compare the results to the real world. through the establishment of a trauma injury scale known as the Abbreviated Injury Scale (AIS) [13]. The AIS is internationally accepted and is the primary tool to conclude injury severity and is Some studies have used also Multi-Body Models which are good [11,12] use detailed FE model and classical means of determining anatomically based. It has been derived by consensus as a global for kinematics but not so good for injuries [8-10]. Other studies fall velocities. They output their results against a range of mechanical parameters such as the von Mises stress, or Maximum severity scoring system that classifies each injury by body region Principal Strain (MPS) and show reasonable correlation; however, ordinal scale, it provides a standardized terminology to describe according to its relative importance (threat to life) on a 6-point they could not assess the injury severity. injuries and it ranks injuries by severity (Table 1) [13]. TableMedical 1: AIS levelprofessionals and risk to havelife. defined real-life injury severity AIS Level Injury Risk of Death % 1 Minor 0 2 Moderate 3 Serious 0.1-0.4 4 Severe 0.8-2.1 5 Critical 7.9-10.6 6 53.1-58.4100 Some initial work by the authors have investigated brainUn-survivable PVP) always increases, never to return. A typical pattern of this behaviour is illustrated in (Figure 1), power (energy input per called Peak Virtual Power (PVP). PVP is based on the general unit time) goes up and down, while PVP stays at the previous injuries in pedestrian-to-vehicle collisions [14] using a concept principle of the 2nd law of thermodynamics, stating that entropy maximum value of power throughout, PVP being also proportional to the maximum rate of Entropy production. 17]. When a collision takes place, the entropy (represented by (state of disorder) increases after each mechanical process [15- Figure 1: Power goes up and down, while trauma (which obeys a cumulative effect and relates to the previous maximum insult to the body organs, hence here represented by PVP) keeps on increasing. It is assumed that the Damage Tensor is proportional to Injury Equation 1: PVP general equation Severity or AIS [15]. The general PVP formulation is provided in This method has been shown that it is possible to compute the (Equation 1). The full derivation and application to a fall have been white and grey matter injury severity in a fall, using the THUMS published [18], taking into account ageing effects (brain shrinkage 4.01 human head model [19], by calibrating the PVP necessary and material properties degeneration), as well as the stiffness of to reach the maximum MPS value in those areas of interest in the impacted surface. PVP is function of the impact velocity. ⋅ the brain (Table 2) [20,21]. Once this maximum power value for PVP ∝max( ∝⋅ε ) ∝AIS other AIS values [14], as illustrated in (Figure 2). a specific AIS value is known, it is possible to interpolate all the How to cite this article: C Bastien, C Neal Sturgess, H Davies, J Hardwicke, T Cloake, et al. A Generic Brain Trauma Computer Framework to Assess 0048 Brain Injury Severity and Bridging Vein Rupture in Traumatic Falls. J Head Neck Spine Surg. 2021; 4(4): 555641. DOI: 10.19080/JHNSS.2021.04.555641 Journal of Head Neck & Spine Surgery Figure 2: Organ Trauma Model (OTM) for a head impact of the forehead against a rigid impactor. Table 2: Brain white and grey matter Maximal Principal Strain tolerance limits. Body Part Load Threshold AIS level Brain contusion (Grey Matter) Maximum principal strain 26% (20) 3 Diffuse Axonal Injury (DAI) (White Matter) Maximum principal strain 21% (21) 4 This previous study, however, had to estimate the state of grey matter elements. This added implementation is convenient, however it has little relationship with the real brain biomechanics, on contact volume elements, hence no volume loss due to blood as bleeding is actually caused by rupture of bridging veins, which brain bleeding. The THUMS 4.01 finite element model is built loss can be accounted for as part of the calculations. To factor are missing in the THUMS model. Upon reaching this critical MPS in, and include the bleeding effect, one has then to include the threshold, the AIS predicted by using PVP was augmented by ‘1’ for a small bleed, or by ‘2’ if the bleeding is judged to be important occurring for an MPS value of 25.5% [22] on the surface of the by the pathologist [23]. effects of Subdural Hematoma (SDH), which has been defined as Figure 3: Bridging veins scan modelled in previous work. How to cite this article: C Bastien, C Neal Sturgess, H Davies, J Hardwicke, T Cloake, et al. A Generic Brain Trauma Computer Framework to Assess 0049 Brain Injury Severity and Bridging Vein Rupture in Traumatic Falls. J Head Neck Spine Surg. 2021; 4(4): 555641. DOI: 10.19080/JHNSS.2021.04.555641 Journal of Head Neck & Spine Surgery The problem with this method is that the AIS shift depends Postmortem report. on the subjective observation of the pathologist and can only be known posteriori. Consequently, the inclusion of a bridging vein Materials and Methods into the previous work is therefore necessary. Very few bridging vein models exist. The most detailed one has been developed and is to investigate the bridging veins material properties, then the The methodology used will consist of three steps. The first one meshing, analysis and validation [24,25], as illustrated in (Figure in the THUMS 4.01 head model (adjusted for brain shrinking and validated based on a CT-Scan, then converted into a CAD model for finite element modelling strategies, followed finally by a validation 3). brain white and grey matter properties) in a fall scenario. Bridging veins material properties, geometry and of the precise location of the veins and some geometrical features This model is admittedly, somewhat patient specific, because current models (such as diameter, wall thickness etc.).
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