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Head trauma,emergency

Helen Fagerlind, Lara Harvey, Stefan Candefjord, Johan Davidsson, Julie Brown
BACKGROUND: Prehospital undertriage occurs when the required level of care for a major trauma patient is underestimated and the patient is transported to a lower-level emergency care facility. One possible reason is that the pattern of injuries exceeding a certain severity threshold is not easily recognizable in the field. The present study aims to examine whether the injury patterns of major road trauma patients are associated with trauma centre transport decisions in Sweden, controlling for the distance from the crash to the nearest trauma centre and other patient characteristics...
February 13, 2019: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
M Rochoy, V Rivas, E Chazard, E Decarpentry, G Saudemont, P-A Hazard, F Puisieux, S Gautier, R Bordet
Alzheimer's disease (AD) is a frequent pathology, with a poor prognosis, for which no curative treatment is available in 2018. AD prevention is an important issue, and is an important research topic. In this manuscript, we have synthesized the literature reviews and meta-analyses relating to modifiable risk factors associated with AD. Smoking, diabetes, high blood pressure, obesity, hypercholesterolemia, physical inactivity, depression, head trauma, heart failure, bleeding and ischemic strokes, sleep apnea syndrome appeared to be associated with an increased risk of AD...
2019: Journal of Prevention of Alzheimer's Disease
David Leo Jolley, Bryan Upham, Lynne Fullerton, Robert D Annett
OBJECTIVE: The objective of this study was to evaluate the effect of the Pediatric Emergency Care Applied Research Network (PECARN) blunt head trauma guidelines and implementation of urgent neurology follow-up (UNF) appointments on an observed decline in head computed tomography (CT) use for pediatric emergency department (PED) patients presenting with headache, seizure, and trauma. METHODS: Patients ages 0 to 18 years presenting to and discharged from an urban tertiary care PED with chief complaint of trauma, headache, and seizure between 2007 and 2013 were retrospectively included...
February 8, 2019: Pediatric Emergency Care
James E McKinley, Allen Perkins
Family physicians may be the first point of contact for adults with new-onset seizure. There are many etiologies of seizures in adults. Etiologies of provoked seizures include temporary metabolic disturbances, central nervous system infections, cerebrovascular disease, drug withdrawal, and traumatic brain injury. Stable or evolving cerebral conditions can cause unprovoked seizures. Nonorganic etiologies include nonepileptiform convulsions, such as a pseudoseizure, which are psychogenic. In the emergency department setting, computed tomography scan of the head should be considered for all patients with new-onset seizure...
February 2019: FP Essentials
Brittany M Stopa, Stefano Amoroso, Luca Ronfani, Elena Neri, Egidio Barbi, Lois K Lee
BACKGROUND: Pediatric head trauma management varies between emergency departments globally. Here we aim to compare the pediatric minor head trauma management between a US and Italian hospital. METHODS: We conducted a retrospective chart review of children 0-18 years old presenting after minor head trauma (Glasgow Coma Scale 14-15) from two emergency departments, in Boston, Massachusetts, United States and Trieste, Italy, between January and December 2013. Frequencies of demographic, clinical, and management characteristic were calculated...
February 11, 2019: Italian Journal of Pediatrics
Eveline A J van Rein, Rogier van der Sluijs, Frank J Voskens, Koen W W Lansink, R Marijn Houwert, Rob A Lichtveld, Mariska A de Jongh, Marcel G W Dijkgraaf, Howard R Champion, Frank J P Beeres, Luke P H Leenen, Mark van Heijl
Importance: Prehospital trauma triage protocols are used worldwide to get the right patient to the right hospital and thereby improve the chance of survival and avert lifelong disabilities. The American College of Surgeons Committee on Trauma set target levels for undertriage rates of less than 5%. None of the existing triage protocols has been able to achieve this target in isolation. Objective: To develop and validate a new prehospital trauma triage protocol to improve current triage rates...
February 6, 2019: JAMA Surgery
Katherine W Turk, Andrew E Budson
PURPOSE OF REVIEW: This article provides a discussion on the current state of knowledge of chronic traumatic encephalopathy (CTE), with an emphasis on clinical features and emerging biomarkers of the condition. RECENT FINDINGS: The results of several large brain bank case series among subjects with a history of contact sports or repetitive head trauma have indicated that a high frequency of CTE may exist in this population. However, the true prevalence of CTE among individuals with a history of head trauma remains unknown, given that individuals who experienced cognitive, behavioral, and mood symptoms during life are more likely to have their brains donated for autopsy at death and epidemiologic studies of the condition are lacking...
February 2019: Continuum: Lifelong Learning in Neurology
Andrew Kaddis, Thomas Tellez
Syncope is a common emergency department (ED) chief complaint, with many known but also unknown causes. Here we present a novel ED presentation of a young woman with new-onset hyperthyroidism that masqueraded as a syncopal event with head trauma. A 21-year-old woman arrived in the ED with head trauma as the result of seemingly unprovoked syncope, due to her history as well as the nature of her trauma. Persistent tachycardia during her ED course after an unremarkable full trauma evaluation prompted ordering of additional lab testing, which revealed evidence of thyrotoxicosis...
January 15, 2019: American Journal of Emergency Medicine
Bardia Barimani, Rayan Fairag, Fahad Abduljabbar, Ahmed Aoude, Carlo Santaguida, Jean Ouellet, Michael Weber
Background: Traumatic atlanto-axial rotatory subluxation (AARS) in an adult is a rare condition, which if left untreated can be fatal. In addition to this, many symptoms experienced such as neck pain and stiffness are non-specific which often leads to misdiagnosis, thus delaying definitive treatment. AARS can be divided into traumatic and non-traumatic causes with the latter generally encompassing congenital cervical spine abnormalities. Case presentation: We present a case of a 66-year-old female with traumatic rotatory AARS, which was initially misdiagnosed in the emergency department...
2019: Open Access Emergency Medicine: OAEM
Makoto Aoki, Toshikazu Abe, Daizoh Saitoh, Kiyohiro Oshima
Limited information exists regarding the epidemiology, patterns of treatment, and mortality of pediatric trauma patients in Japan. To evaluate the characteristics and mortality of pediatric trauma patients in Japan, especially in traffic accidents. This was a retrospective cohort study between 2004 and 2015 from a nationwide trauma registry in Japan. Pediatric trauma patients divided into four age groups: <1 years; 1 ≤ 5 years; 6 ≤ 10 years; and 11 ≤ 15 years. Data on patients' demographics, trauma mechanism and severity, treatments and in-hospital mortality were analyzed between the groups...
January 29, 2019: Scientific Reports
Faris Haddadin, Alba Munoz Estrella, Eyal Herzog
Hypertensive crisis is a serious medical condition defined as severely elevated blood pressure; typically the systolic blood pressure is above 180 mmHg, and/or the diastolic blood pressure is above 120 mmHg. Hypertensive crises are divided into two categories: hypertensive urgency and hypertensive emergency. Hypertensive urgency is asymptomatic while hypertensive emergency presents with end-organ damage requiring more aggressive blood-pressure lowering. The common presentations for neurological end-organ dysfunction in conjunction with hypertensive emergency include ischemic strokes, intracranial hemorrhage, subarachnoid hemorrhage, head trauma, and hypertensive encephalopathy...
January 2019: Journal of Cardiology Cases
Jason Seidel, Mary Beth Bissell, Sannihita Vatturi, Angus Hartery
PURPOSE: To explore resource utilization through evaluation of computed tomography (CT) imaging trends in the emergency department by examining common indications/outcomes for imaging in this setting. METHODS: A retrospective analysis of clinical indications/outcomes for all CT imaging in 3 emergency departments over a 1-year period was conducted. Scans were divided by body part and the most common indications for each type of scan were determined. Clinical outcomes from each study were extracted from final interpretations by the reporting radiologist...
February 2019: Canadian Association of Radiologists Journal, Journal L'Association Canadienne des Radiologistes
Megan Cox, Timothy Becker, Mpapho Motsumi
This study aims to present and discuss acute Head Injury (HI) presentations including etiology, referral patterns and disposition in patients presenting to a major referral hospital in Gaborone, Botswana. Cross-sectional, retrospective data collection from July 2015 through September 2015 extracted descriptions of patient demographics, mechanism of injury, comorbidities, diagnosis and disposition from Emergency Centre (EC) records. 360 HI patients presented in three months, averaging four per day and increasing on weekends and end of the month...
October 1, 2018: Journal of Public Health in Africa
Raffaele Pascarella, Rossana Fantasia, Pasquale Sangiovanni, Alessandra Maresca, Daniele Massetti, Rocco Politano, Simone Cerbasi
Traumatic hip fracture dislocation is a rare injury associated with high-energy trauma. Most of these injuries should be surgically treated. Hip dislocation is an orthopaedic emergency and reduction must be performed within 6-8 hours of trauma. We performed a retrospective analysis of 69 patients with "hip joint associated injuries", treated between January 2002 and December 2016. 33 patients were assessed at a mean follow-up of 36.9 months (range 18-132) after surgery. We propose a new classification system in which, different patterns of fracture (head and/or neck and/or acetabular) are described according to different types of hip dislocation...
January 17, 2019: Injury
Hakan Yilmaz, Ozlem Yilmaz
AIM: We investigated the pediatric patients who presented with isolated head trauma to the emergency service and where abnormal findings were detected on brain computed tomography to evaluate the follow-up scan rate and whether the follow-up scans affect the treatment protocol. MATERIAL AND METHODS: Pediatric patients who presented to the emergency service between 2014 and 2017 with isolated head trauma and were later found to have abnormal findings on CT were evaluated...
January 21, 2019: World Neurosurgery
Daniel J Corwin, Dennis R Durbin, Katie L Hayes, Mark R Zonfrillo
OBJECTIVE: The aims of this study were to evaluate trends over time in computed tomography (CT) scan utilization after implementation of a clinical pathway in a tertiary care children's hospital emergency department (ED), to determine how ED throughput differs by CT utilization, and to determine provider reasoning for obtaining head CT in low-risk patients. METHODS: This was a retrospective cohort study of patients 21 years or younger discharged from our ED with head trauma (Glasgow Coma Scale score ≥13 and a head trauma International Classification of Diseases code) over a 5-year period, starting 1 year after pathway implementation (January 2012 to December 2016)...
January 21, 2019: Pediatric Emergency Care
Sadaf Sahraian, Elham Beheshtian, Arya Haj-Mirzaian, Matthew D Alvin, David M Yousem
PURPOSE: The ACR Appropriateness Criteria recommend performing noncontrast head CT (NCCT) for patients with sudden severe headache ("worst headache of life" [WHOL] or "thunderclap headache" [TCH]). The aim of this study was to assess the value of NCCT scanning in patients with known migraine histories and WHOL or TCH. The hypothesis was that there would be little utility in performing emergency department (ED) NCCT scans in migraineurs without other red flags, even if they had WHOL or TCH...
January 17, 2019: Journal of the American College of Radiology: JACR
Burak Eren, Abdurrahim Tas, Feyza Karagoz Guzey, Ilker Gulec, Azmi Tufan, Murat Karacan
AIM: The purpose of this study is to identify, report, and raise awareness of the risk factors for television (TV) tip-over. MATERIAL AND METHODS: In total, 86 children who were brought to the emergency service and hospitalized in the neurosurgery clinic between August 2011 and August 2016 because of TV tip-over-related head trauma were included in the study. RESULTS: Of these 86 patients, 47 boys and 39 girls. The mean age was 38.8 ± 19...
June 11, 2018: Turkish Neurosurgery
David Migneault, Albert Chang, Edward Choi, Quynh Doan
Background Falls are a leading cause of childhood trauma and are the most common mechanism of injury seen in the emergency department (ED). Playground injuries represent a significant fraction of these falls. Objectives This study aims to compare the frequencies of fractures from monkey bars to other types of falls and to explore the statistical associations between the types of injuries. Methods We conducted a cross-sectional study through a retrospective chart review of all British Columbia Children's Hospital ED visits between March 2011 and February 2012...
November 5, 2018: Curēus
Erik P Hess, James L Homme, Anupam B Kharbanda, Leah Tzimenatos, Jeffrey P Louie, Daniel M Cohen, Lise E Nigrovic, Jessica J Westphal, Nilay D Shah, Jonathan Inselman, Michael J Ferrara, Jeph Herrin, Victor M Montori, Nathan Kuppermann
Importance: The Pediatric Emergency Care Applied Research Network prediction rules for minor head trauma identify children at very low, intermediate, and high risk of clinically important traumatic brain injuries (ciTBIs) and recommend no computed tomography (CT) for those at very low risk. However, the prediction rules provide little guidance in the choice of home observation or CT in children at intermediate risk for ciTBI. Objective: To compare a decision aid with usual care in parents of children at intermediate risk for ciTBI...
September 7, 2018: JAMA network open
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