Primary prevention
Use of helmets during recreational activities has improved safety in the civilian population. Studies on sports such as American football, ice hockey, and rugby (where padded headgear may be used) have demonstrated a significant reduction in severe head trauma and skull and facial fractures.[15][16] Studies of recreational activities such as snowboarding, skiing, all terrain vehicle riding, and bicycling have also demonstrated a significant risk reduction in head trauma with helmet use.[17][18][19][20][21] Studies on helmet use in riders of bicycles, all-terrain vehicles, and motorcycles have consistently demonstrated a significant reduction in death and head injury.[21][22] In motorcycle riders who crash, a reduction of almost 70% of head injuries has been reported as a result of wearing helmets.[23][24]
However, data from the military have demonstrated a disturbingly high rate of traumatic brain injury, including skull fractures, even with the presence of personal protective gear, including helmets.[8] Gunshot wounds to the head in military personnel wearing helmets actually intensified rather than diminished the damage done by the missile and the severity of head injury.[25] A possible explanation is that combat-related head injuries often result from high-velocity missiles, or from explosions. High-velocity missiles will be able to penetrate more deeply through a helmet than low-velocity missiles. Even if a high-velocity bullet does not penetrate the helmet, the force behind the missile is capable of fracturing the skull through the helmet and injuring the underlying brain. Additionally, injury from explosions is, in part, caused by blast effect, and these pressure waves may not be stopped by personal protective gear.
Primary prevention policy to strengthen family functioning, such as intensive home-visiting programs with parent training, may be beneficial.[26] Family-specific programs for inflicted head injury prevention, involving educational videos in neonatal units with a signed agreement by parents not to shake their baby, have also shown some benefits.[27] Public and professional awareness campaigns may also be beneficial, although evaluation of effect is difficult.
Secondary prevention
For children with skull fractures as a consequence of potential child abuse, it is important to consult with a hospital child protection team and social work services as soon as possible. See Child abuse. Child protective services will assess risk of reinjury of the patient and other children with the same caregiver. After assessing family and other caregivers, child protective services may take steps to remove children from exposure to the offending caregiver. Additionally, the majority of cases of inflicted brain injury will be referred to police or the district attorney for criminal investigation.
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