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https://www.readbyqxmd.com/read/29784284/routine-surveillance-imaging-following-mild-traumatic-brain-injury-with-intracranial-hemorrhage-may-not-be-necessary
#1
Smruti K Patel, Yair M Gozal, Bryan M Krueger, James C Bayley, Suzanne Moody, Norberto Andaluz, Richard A Falcone, Karin S Bierbrauer
BACKGROUND: Mild traumatic brain injury (mTBI) comprises the majority of pediatric traumatic brain injury. Children with mTBI even with traumatic intracranial hemorrhage (tICH) rarely experience a clinically significant neurologic decline (CSND). The utility of routine surveillance imaging in the pediatric population also remains controversial, especially owing to concerns about the risks of radiation exposure at a young age. This study aims to identify demographic or injury-related characteristics that may facilitate recognition of children at risk of progression with mTBI...
April 27, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29774195/development-of-delayed-acute-subdural-hematoma-after-mild-traumatic-brain-injury-a-case-report
#2
Soon O Hong, Dong Soo Kang, Min Ho Kong, Se Youn Jang, Jung Hee Kim, Kwan Young Song
We report a case involving the development of a delayed acute subdural hematoma (ASDH) after trauma, with the absence of any abnormal radiological and clinical findings at initial examination. A 54-year-old male visited the emergency department after a minor trauma. The patient only complained of mild headache after head injury. He presented no abnormal findings on neurological examination, and brain computed tomography (CT) did not show any intracranial lesion or skull fractures. However, he developed seizure with disorientation eight hours after trauma, and ASDH with midline shift was found during a follow-up CT...
April 2018: Korean Journal of Neurotrauma
https://www.readbyqxmd.com/read/29768294/a-pilot-study-to-reduce-computed-tomography-utilization-for-pediatric-mild-head-injury-in-the-emergency-department-using-a-clinical-decision-support-tool-and-a-structured-parent-discussion-tool
#3
Rakesh S Engineer, Seth R Podolsky, Baruch S Fertel, Purva Grover, Heather Jimenez, Erin L Simon, Courtney M Smalley
INTRODUCTION: The American College of Emergency Physicians embarked on the "Choosing Wisely" campaign to avoid computed tomographic (CT) scans in patients with minor head injury who are at low risk based on validated decision rules. We hypothesized that a Pediatric Mild Head Injury Care Path could be developed and implemented to reduce inappropriate CT utilization with support of a clinical decision support tool (CDST) and a structured parent discussion tool. METHODS: A quality improvement project was initiated for 9 weeks to reduce inappropriate CT utilization through 5 interventions: (1) engagement of leadership, (2) provider education, (3) incorporation of a parent discussion tool to guide discussion during the emergency department (ED) visit between the parent and the provider, (4) CDST embedded in the electronic medical record, and (5) importation of data into the note to drive compliance...
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29768041/getting-hit-by-pitch-in-professional-baseball-analysis-of-injury-patterns-risk-factors-concussions-and-days-missed-for-batters
#4
Christopher L Camp, Dean Wang, Alec S Sinatro, John D'Angelo, Struan H Coleman, Joshua S Dines, Stephen Fealy, Stan Conte
BACKGROUND: Although batters are frequently hit by pitch (HBP) in baseball, the effect of HBP injuries remains undefined in the literature. PURPOSE: To determine the effect of HBP injuries in terms of time out of play, injury patterns resulting in the greatest time out of play, and the value of protective gear such as helmets and elbow pads. STUDY DESIGN: Descriptive laboratory study. METHODS: Based on the Major League Baseball (MLB) Health and Injury Tracking System, all injuries to batters HBP during the 2011-2015 MLB and Minor League Baseball (MiLB) seasons were identified and analyzed...
May 1, 2018: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/29753518/application-of-the-canadian-computed-tomography-head-rule-to-patients-with-minimal-head-injury
#5
Kevin Davey, Turandot Saul, Geoffrey Russel, Jonathan Wassermann, Joshua Quaas
STUDY OBJECTIVE: Two clinical decision rules, the Canadian CT Head Rule and the New Orleans Criteria, set the standard to guide clinicians in determining which patients with minor head trauma need computed tomography (CT) imaging. Both rules were derived with patients with minor head injury who had had a loss of consciousness or witnessed disorientation. No evidence exists for evaluating patients and need for CT imaging with minimal head injury; that is, patients who had a head injury but no loss of consciousness or disorientation and therefore would have been excluded from the Canadian CT Head Rule and New Orleans Criteria trials...
May 9, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29740509/chiari-i-malformation-with-acute-neurological-deficit-after-craniocervical-trauma-case-report-imaging-and-anatomic-considerations
#6
Josha A Woodward, David E Adler
Background: In patients with Chiari I malformation (CMI), the occurrence of acute neurologic deficit after craniocervical trauma is rare. However, the pathologic potential of exacerbating anatomic overcrowding of the posterior fossa has immense clinical consequences and prompt recognition is essential. Case Description: This case study describes a 41-year-old male who sustained a single blow to the face, fell, and struck the occiput. On admission, neurological examination revealed a profound paraparesis, upper extremity diplegia, a C4 sensory level and apnea that required intubation...
2018: Surgical Neurology International
https://www.readbyqxmd.com/read/29735181/maxillofacial-injuries-in-patients-with-major-trauma
#7
D M McGoldrick, M Fragoso-Iñiguez, T Lawrence, K McMillan
Major trauma is an important cause of mortality and morbidity worldwide. Mortality is high with rates over 10% commonly reported. We studied the epidemiology and aetiology of maxillofacial injuries in patients who presented with major trauma as recorded nationally by retrospectively analysing the database of the Trauma Audit Research Network from 2001 to 2015. All patients who had major trauma with associated maxillofacial injuries were included in the analysis. Of 104645 patients recorded as having had major trauma during the study period, 22148 (21...
May 4, 2018: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/29698343/the-effect-of-an-observation-unit-on-pediatric-minor-head-injury
#8
Yusuke Hagiwara, Nobuaki Inoue
OBJECTIVE: The aim of this study was to evaluate the effect of an observation unit (OU) in an emergency department on reducing unnecessary use of computed tomography (CT) for minor blunt head trauma. METHODS: This study was a retrospective before-and-after study of pediatric patients 18 years or younger with minor blunt head trauma. Patients with a Glasgow Coma Scale score of 14 or 15 who presented to the emergency department were included in the analysis. The rates of head CT use in the period before and after the institution of the OU were compared...
April 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29628665/computed-tomography-profile-and-its-utilization-in-head-injury-patients-in-emergency-department-a-prospective-observational-study
#9
Archana Waganekar, Jagadish Sadasivan, A Sathia Prabhu, K T Harichandrakumar
Context: Based on Glasgow Coma Scale (GCS), head injury can be classified as minor (GCS 13-15), moderate (GCS 9-12), and severe (GCS 3-8). There is a lot of controversy in the use of computed tomography (CT) in head injury patients. Aims: This study was intended to estimate the rate of CT positivity in head injury patients and to define the criteria for doing CT in head injury patients. Settings and Design: This was a prospective observational study in the emergency department (ED) over a 12-month period...
January 2018: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/29625747/brain-tissue-strains-vary-with-head-impact-location-a-possible-explanation-for-increased-concussion-risk-in-struck-versus-striking-football-players
#10
REVIEW
Benjamin S Elkin, Lee F Gabler, Matthew B Panzer, Gunter P Siegmund
BACKGROUND: On-field football helmet impacts over a large range of severities have caused concussions in some players but not in other players. One possible explanation for this variability is the struck player's helmet impact location. METHODS: We examined the effect of impact location on regional brain tissue strain when input energy was held constant. Laboratory impacts were performed at 12 locations distributed over the helmet and the resulting head kinematics were simulated in two finite element models of the brain: the Simulated Injury Monitor and the Global Human Body Model Consortium brain model...
March 29, 2018: Clinical Biomechanics
https://www.readbyqxmd.com/read/29622334/pediatric-major-head-injury-not-a-minor-problem
#11
REVIEW
Aaron N Leetch, Bryan Wilson
Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Initial Glasgow Coma Score, hyperglycemia, and imaging are often prognostic of outcome. Surgically amenable lesions should be evacuated promptly...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29622323/pediatric-minor-head-injury-2-0-moving-from-injury-exclusion-to-risk-stratification
#12
REVIEW
James Jim L Homme
Visits for pediatric minor blunt head trauma continue to increase. Variability exists in clinician evaluation and management of this generally low-risk population. Clinical decision rules identify very low-risk children who can forgo neuroimaging. Observation before imaging decreases neuroimaging rates. Outcome data can be used to risk stratify children into more discrete categories. Decision aids improves knowledge and accuracy of risk perception and facilitates identification of caregiver preferences, allowing for shared decision making...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29606408/racial-and-ethnic-disparities-and-bias-in-the-evaluation-and-reporting-of-abusive-head-trauma
#13
Kent P Hymel, Antoinette L Laskey, Kathryn R Crowell, Ming Wang, Veronica Armijo-Garcia, Terra N Frazier, Kelly S Tieves, Robin Foster, Kerri Weeks
OBJECTIVE: To characterize racial and ethnic disparities in the evaluation and reporting of suspected abusive head trauma (AHT) across the 18 participating sites of the Pediatric Brain Injury Research Network (PediBIRN). We hypothesized that such disparities would be confirmed at multiple sites and occur more frequently in patients with a lower risk for AHT. STUDY DESIGN: Aggregate and site-specific analysis of the cross-sectional PediBIRN dataset, comparing AHT evaluation and reporting frequencies in subpopulations of white/non-Hispanic and minority race/ethnicity patients with lower vs higher risk for AHT...
March 29, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29569683/computed-tomography-use-in-minor-head-injury-attitudes-and-practices-of-emergency-physicians-neurosurgeons-and-radiologists-in-turkey
#14
Ebru Özan, Gökçe Kaan Ataç
BACKGROUND: We aimed to determine the attitudes and practices of emergency physicians (EPs), neurosurgeons, and radiologists in Turkey regarding computed tomography (CT) use for adults with minor head injury (MHI). METHODS: This cross-sectional study was conducted between August 2015 and October 2016 after obtaining the approval of the institutional ethical committee. The purpose of this study was disclosed to the participants prior to beginning the survey. The study was performed conducting a questionnaire via e-mail on three groups of participants including EPs, neurosurgeons, and radiologists...
March 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/29569001/the-alcohol-intoxicated-trauma-patient-impact-on-imaging-and-radiation-exposure
#15
Christian David Weber, Jana Kristina Schmitz, Christina Garving, Klemens Horst, Hans-Christoph Pape, Frank Hildebrand, Philipp Kobbe
INTRODUCTION: The purpose of this study was to investigate the effects of alcohol intoxication in trauma patients in regard to its impact on application of computed tomography (CT) and associated radiation exposure. METHODS: We conducted a retrospective study from a continuous patient cohort. INCLUSION CRITERIA: admission to the emergency room of an urban Level 1 trauma center with trauma team activation during a 12-month period (Jan 1st-Dec 31st 2012)...
March 22, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29564212/neglected-traumatic-hip-dislocation-influence-of-the-increased-intracapsular-pressure
#16
Elsayed Ibraheem Elsayed Massoud
AIM: To investigate that the increased intracapsular pressure, during the delay period, can interrupt the blood flow to the femoral head. METHODS: An observational retrospective study included a group of 17 patients with traumatic hip dislocation, their ages at time of injury averaged 26 (range from 3 to 70) years. Outcomes were assessed clinically and radiographically at a period averaged 11.5 (range from 4 to 20) years. RESULTS: Minor trauma caused dislocation in seven and severe trauma in ten patients...
March 18, 2018: World Journal of Orthopedics
https://www.readbyqxmd.com/read/29550926/management-of-mild-traumatic-brain-injury-trauma-energy-level-and-medical-history-as-possible-predictors-for-intracranial-hemorrhage
#17
Tomas Vedin, Sebastian Svensson, Marcus Edelhamre, Mathias Karlsson, Mikael Bergenheim, Per-Anders Larsson
PURPOSE: Head trauma is common in the emergency department. Identifying the few patients with serious injuries is time consuming and leads to many computerized tomographies (CTs). Reducing the number of CTs would reduce cost and radiation. The aim of this study was to evaluate the characteristics of adults with head trauma over a 1-year period to identify clinical features predicting intracranial hemorrhage. METHODS: Medical record data have been collected retrospectively in adult patients with traumatic brain injury...
March 17, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29541804/evaluation-of-a-protocol-for-early-detection-of-delayed-brain-hemorrhage-in-head-injured-patients-on-warfarin
#18
Jing Li Huang, Theo A Woehrle, Pat Conway, Catherine A McCarty, Madeline M Eyer, Steven D Eyer
PURPOSE: In 2007, Essentia Health St. Mary's Medical Center (SMMC), a Level II trauma center in northeastern Minnesota, implemented a protocol for patients who presented with blunt head trauma and were receiving warfarin for anticoagulation. The purpose of this study was to determine the incidence and risk factors of early delayed, warfarin-associated intracranial hemorrhage (ICH). METHODS: Adult patients with signs and symptoms of head injury on warfarin who were admitted by protocol to SMMC between March 2007 and June 2015 were included...
March 14, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29530228/the-use-of-ct-in-the-management-of-minor-head-injuries-in-queenstown
#19
Jennifer Keys, Louise Venter, Garry Nixon
AIM This study retrospectively reviewed the management of head injury at Lakes District Hospital in Queenstown, New Zealand. The aim is to describe the management of minor head injury with particular reference to the current Traumatic Brain Injury guidelines of the New Zealand Guidelines Group. METHODS We identified all patients with head injury as a primary diagnosis who were seen in the Emergency Department at Lakes District Hospital during 2013-2015. We recorded clinical criteria indicating need for computed tomography (CT) scanning according to current guidelines for management of minor head injury...
June 2017: Journal of Primary Health Care
https://www.readbyqxmd.com/read/29516354/overuse-of-computed-tomography-for-minor-head-injury-in-young-patients-an-analysis-of-promoting-factors
#20
Michaela Cellina, Marta Panzeri, Chiara Floridi, Carlo Maria Andrea Martinenghi, Giulio Clesceri, Giancarlo Oliva
AIM: To assess the amount of computed tomography (CT) scans for minor head injury (MHI) performed in young patients in our emergency department (ED), not indicated by National Institute for Health and Clinical Excellence (NICE) and Canadian Computed Tomography Head Rules (CCHR), and to analyze factors contributing to unnecessary examinations. Secondary objectives were to calculate the effective dose, to establish the number of positive CT and to analyze which of the risk factors are correlated with positivity at CT; finally, to calculate sensitivity and specificity of NICE and CCHR in our population...
March 7, 2018: La Radiologia Medica
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