The Role of Head CT Scans in the Evaluation of Acute Intracranial Injuries in Patients Whom Fell During a Stay on an Acute Inpatient Rehabilitation Unit

PM&R ◽  
2013 ◽  
Vol 5 ◽  
pp. S141-S142
Author(s):  
Kirill Alekseyev ◽  
Adrian Cristian ◽  
Marc K. Ross
Keyword(s):  
Inpatient Rehabilitation ◽  
Ct Scans ◽  
Rehabilitation Unit ◽  
Head Ct

The Role Of Head CT Scans In The Evaluation of Acute Intracranial Injuries

2016 ◽  
Vol 1 (1) ◽  
pp. 1
Author(s):  
Kirill Alekseyev ◽  
Zachary Fallon ◽  
Malcolm Lakdawala ◽  
Adrian Cristian ◽  
Marc Ross
Keyword(s):  
Ct Scans ◽  
Head Ct

Is Head Computerized Tomography Indicated for the Workup of Headache in Patients with Intact Neurological Examination

2018 ◽  
Vol 80 (5-6) ◽  
pp. 341-344
Author(s):  
Lilach Goldstein ◽  
Tamar Laytman ◽  
Israel Steiner
Keyword(s):  
Emergency Department ◽  
Ct Scans ◽  
Neurologic Examination ◽  
Head Ct ◽  
The Past ◽  
Radiation Induced Cancer ◽  
Radiation Induced ◽  
Clinically Significant ◽  
Rule Out

Introduction: The use of neuroimaging as part of the initial workup in the emergency department (ED) for patients with atraumatic headache is increasing, whereas the proportion of cases in which clinically significant intracranial pathology is detected is decreasing. In the last few decades, the exposure to medical ionized radiation from utilization of computer tomography (CT) increased dramatically, raising concern about radiation-induced cancer. Different guidelines were suggested to address the role of neuroimaging in the investigation of adult patients presenting to the ED with nontraumatic headache. Materials and Methods: We retrospectively evaluated data from all consecutive patients who underwent a head CT in the ED for the evaluation of headache during 2015. Patients were included only if a normal neurologic examination was documented. Results: In total, 422 patients were included. About 43.4% of scans were normal. Most abnormal findings were sinusitis (148 patients, 35%) or ischemic changes. Seven CT scans (1.6%) showed clinically significant findings requiring an immediate change in management. Conclusion: A normal neurologic examination, even when performed by a neurologist, does not rule out a significant secondary cause for headache. A CT scan in the ED is indicated for patients presenting with severe nonremitting headache who never had neuroimaging in the past.

scholarly journals Role of repeat CT in mild to moderate head injury: an institutional study

2019 ◽  
Vol 47 (5) ◽  
pp. E2 ◽  
Author(s):  
Madhusudhan Nagesh ◽  
Kautilya Rajendrakumar Patel ◽  
Ajit Mishra ◽  
Ujwal Yeole ◽  
Andiperumal R. Prabhuraj ◽  
...  
Keyword(s):  
Head Injury ◽  
Ct Scan ◽  
Neurological Deterioration ◽  
Ct Scans ◽  
Midline Shift ◽  
Head Ct ◽  
Gcs Score ◽  
Neurosurgical Intervention ◽  
Basal Cisterns

OBJECTIVEPatients with traumatic brain injury (TBI) often undergo repeat head CT scans to identify the possible progression of injury. The objective of this study is to evaluate the need for routine repeat head CT scans in patients with mild to moderate head injury and an initial positive abnormal CT scan.METHODSThis is a retrospective study of patients presenting to the emergency department from January 2016 to December 2017 with Glasgow Coma Scale (GCS) scores > 8 and an initial abnormal CT scan, who underwent repeat CT during their in-hospital medical management. Patients who underwent surgery after the first CT scan, had a GCS score < 9, or had a normal initial CT scan were excluded. Demographic, medical history, and physical examination details were collected, and CT scans were reviewed. Radiological deterioration, neurological deterioration, and/or the need for neurosurgical intervention were the primary outcome variables.RESULTSA total of 1033 patients were included in this study. These patients underwent at least two CT scans on an inpatient basis. Of these 1033 patients, 54.1% had mild head injury and 45.9% had moderate head injury based on GCS score at admission. The most common diagnosis was contusion (43.8%), followed by extradural hematoma (28.8%) and subdural hematoma (26.6%). A total of 2636 CT scans were performed for 1033 patients, with a mean of 2.55 per patient. Of these, 25 (2.4%) had neurological deterioration, 90 (8.7%) had a progression of an existing lesion or appearance of a new lesion on repeat CT, and 101 (9.8%) required neurosurgical intervention. Seventy-five patients underwent surgery due to worsening of repeat CT without neurological deterioration, so the average number of repeat CT scans required to identify one such patient was 21.3. On multiple logistic regression, GCS score at admission (p = 0.024), abnormal international normalized ratio (INR; p < 0.001), midline shift (p = 0.005), effaced basal cisterns (p < 0.001), and multiple hemorrhagic lesions (p = 0.010) were associated with worsening of repeat CT, neurological deterioration, and/or need for neurosurgical intervention.CONCLUSIONSThe role of routine repeat head CT in medically managed patients with head injury is controversial. The authors have tried to study the various factors that are associated with neurological deterioration, radiological deterioration, and/or need for neurosurgical intervention. In this study the authors found lower GCS score at admission, abnormal INR, presence of midline shift, effaced basal cisterns, and multiple lesions on initial CT to be significantly associated with the above outcomes.

scholarly journals Not All That Shines on a PET Scan Is Cancer: A Silicone-Induced Granuloma Masquerading as Malignancy

2020 ◽  
Vol 11 (1) ◽  
pp. 8-12
Author(s):  
Krishna Vedala ◽  
Philip Sobash ◽  
Deborah Johnson ◽  
Krishna Kakkera
Keyword(s):  
Pet Scan ◽  
Imaging Modalities ◽  
Ct Scans ◽  
Pet Ct ◽  
Suspicious Lesions

PET/CT scans are frequently used in the initial workup of suspicious lesions but not all that lights up on a PET is cancerous. We wish to discuss a case of silicone-induced granuloma mimicking malignancy and the role of other imaging modalities for further workup.

Improving WeeFIM score completion rates: An interdisciplinary inpatient rehabilitation unit quality improvement project

2021 ◽  
pp. 1-8
Author(s):  
Ashlee Jaffe ◽  
Maura Powell ◽  
Tami Konieczny ◽  
Carlene Osweiler ◽  
Genna Kreher
Keyword(s):  
Quality Improvement ◽  
Interdisciplinary Team ◽  
Inpatient Rehabilitation ◽  
Visualization Tool ◽  
Completion Rates ◽  
Intervention Period ◽  
Rehabilitation Unit ◽  
Improvement Project ◽  
Comprehensive Therapy ◽  
Therapy Services

PURPOSE: The WeeFIM is a tool commonly used in pediatric rehabilitation settings to measure objective patient progress while receiving comprehensive therapy services on inpatient rehabilitation units. This Quality Improvement (QI) project aimed for 95%of inpatients to have complete, on-time documented and displayed WeeFIM scores upon admission and discharge by 12/2017. METHODS: An interdisciplinary team examined historic WeeFIM completion rates. Using Plan-Do-Study-Act cycles, a unified flowsheet was developed in the electronic health record (EHR) to revamp workflow and identify opportunities for improvement, data accuracy, and finally sustainability. Progress was monitored in real time via an automated data visualization tool which monitored score timeliness and completeness. RESULTS: On-time admission completion rates increased from 0%to 95%during the intervention period. On-time discharge completion rates increased from 0%to 89%during the intervention period. This change has been sustained over 2 years with on-time admission and discharge scores averaging 79.4%and 77.9%respectively, and 96.4%of scores completed. CONCLUSION: Changes in the completion rate of WeeFIMs are sustainable, evidenced by ongoing maintenance of our initial gains over the course of multiple months. The incorporation of WeeFIM documentation into the workflow increased on-time and completion rates. The success of this project shows that integrating new tasks into provider workflows helps drive completion.

scholarly journals Demonstrating the vital role of physiatry throughout the health care continuum: Lessons learned from the impacts of the COVID‐19 pandemic on inpatient rehabilitation

PM&R ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 554-562
Author(s):  
Jonathan H. Whiteson ◽  
Miguel Xavier Escalón ◽  
Susan Maltser ◽  
Monica Verduzco‐Gutierrez
Keyword(s):  
Health Care ◽  
Inpatient Rehabilitation ◽  
Vital Role ◽  
Lessons Learned ◽  
Care Continuum

The Role of the Occupational Therapist in a Community Mental Health Centre in Greece

1986 ◽  
Vol 49 (12) ◽  
pp. 389-391 ◽  
Author(s):  
I Tsipra ◽  
P Voutsina ◽  
E Charitaki ◽  
V Tomaras ◽  
A Kapsali ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Health Centre ◽  
Occupational Therapist ◽  
Community Mental Health Centre ◽  
Rehabilitation Unit ◽  
Care Programme ◽  
Mental Health Centre ◽  
Schizophrenic Patients

This article deals with a developing rehabilitation unit for mentally ill people, mostly chronic schizophrenic patients, which has been integrated into the Community Mental Health Centre of two Athenian boroughs. The unit includes a day care programme, a vocational training workshop and a social therapeutic club. All these programmes have been developed for the first time in Greece at a certain community level. The authors describe the rationale and the structure of the rehabilitation unit and the role of the occupational therapist.

The role of exudation in chronic subdural hematomas

2007 ◽  
Vol 107 (2) ◽  
pp. 290-295 ◽  
Author(s):  
Mehmet Tokmak ◽  
A. Celal Iplikcioglu ◽  
Sirzat Bek ◽  
Cem Atilla Gökduman ◽  
Mustafa Erdal
Keyword(s):  
Outer Membrane ◽  
Clinical Status ◽  
Ct Scans ◽  
Subdural Hematomas ◽  
The Mean ◽  
Grade 3 ◽  
Age Range ◽  
Exudation Rate

Object Chronic subdural hematomas (SDHs) are a local inflammatory process that causes the formation of a granulation tissue often referred to as the external or outer membrane. This membrane has abnormally permeable macrocapillaries. Therefore, exudation from the macrocapillaries in the outer membrane of chronic SDH may play an important role in the enlargement of chronic SDH. In this study the authors investigated the role of exudation in chronic SDH. Methods The authors examined 24 patients (16 men and eight women; age range 38–86 years [mean age 61.4 years]) with 27 chronic SDHs. The clinical status of the patients was evaluated according to the classification described by Markwalder. The diagnosis was established on computed tomography (CT) scans in all cases. The authors also used the Nomura Classification for judging the lesion's appearance on CT scans. Immediately after the diagnosis, all patients were administered 20 mCi (740 mBq) technetium-99m human serum albumin. Four hours later, blood and SDH samples were taken and radioactivity levels were measured in each. The ratio of activity of the samples taken from chronic SDH to the radioactivity of blood was determined as a percentage and defined as the exudation rate. On the follow-up CT scan obtained on postoperative Day 20, subdural collections thicker than 5 mm were determined to be a reaccumulation. Results The correlations between the exudation rate and age of the patients, clinical grades, CT appearances, and amount of reaccumulation were investigated. In this series the average exudation rate was 13.24% (range 2.05–28.88%). The mean exudation rates according to the clinical grades assigned to patients were as follows: Grade 0, 8.67 ± 5.64% (three patients); Grade 1, 5.07 ± 1.43% (eight patients); Grade 2, 17.87 ± 3.73% (seven patients); and Grade 3, 19.65 ± 7.67% (six patients). Exudation rates in patients with Grades 2 and 3 were significantly higher than those in Grades 0 and 1 (p < 0.05). The mean exudation rates according to the lesion's appearance on CT scans were found as follows: hypodense appearance, 6.55 ± 4.52% (eight patients); isodense appearance, 11.07 ± 6.32% (five patients); hyperdense appearance, 19.47 ± 13.61% (three patients); and mixed-density appearance, 17.40 ± 5.80% (nine patients). The differences among the groups were significant (p < 0.05). The average exudation rate was statistically higher in the patients with reaccumulation (16.30 ± 8.16%) than that in the patients without reaccumulation (9.96 ± 6.84%) (p < 0.05). Conclusions The exudation rate in chronic SDH is correlated with a higher clinical grade (Markwalder Grade 2 or 3), mixed-density CT appearance, and reaccumulation. Therefore, exudation from macrocapillaries in the outer membrane of chronic SDH probably plays an important role in the pathophysiology and the growth of chronic SDH.

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