Head Trauma

2018 ◽  
pp. 8-11
Author(s):  
Todd W. Thomsen
Keyword(s):  
Blood Pressure ◽  
Head Injury ◽  
Key Management ◽  
Rapid Assessment ◽  
Decision Rules ◽  
Clinical Decision ◽  
Loss Of Consciousness ◽  
Ct Head ◽  
Neurosurgical Intervention

Head injury is often associated with other serious trauma. Clinical decision rules such as the Canadian CT Head Rule can guide clinicians in the judicious use of neuroimaging, which can then guide the appropriate course of treatment. Rapid assessment of patients requiring neurosurgical intervention is critical, as is appropriate management of blood pressure and hypoxia. This chapter considers a case study of blunt head injury with loss of consciousness of a skier in the backcountry, The author addresses patient history, physical exam, differential diagnoses, clinical course, and key management steps. The patient’s condition relative to the Canadian CT Head Rule is specifically discussed.

Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the Canadian CT Head Rule

2014 ◽  
Vol 120 (2) ◽  
pp. 447-452 ◽  
Author(s):  
Harald Wolf ◽  
Wolfgang Machold ◽  
Sophie Frantal ◽  
Mathias Kecht ◽  
Gholam Pajenda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Elderly Patients ◽  
Head Trauma ◽  
Skull Fracture ◽  
Loss Of Consciousness ◽  
Cranial Ct ◽  
Ct Head ◽  
Gcs Score ◽  
Neurosurgical Intervention

Object This study presents newly defined risk factors for detecting clinically important brain injury requiring neurosurgical intervention and intensive care, and compares it with the Canadian CT Head Rule (CCHR). Methods This prospective cohort study was conducted in a single Austrian Level-I trauma center and enrolled a consecutive sample of mildly head-injured adults who presented to the emergency department with witnessed loss of consciousness, disorientation, or amnesia, and a Glasgow Coma Scale (GCS) score of 13–15. The studied population consisted of a large number of elderly patients living in Vienna. The aim of the study was to investigate risk factors that help to predict the need for immediate cranial CT in patients with mild head trauma. Results Among the 12,786 enrolled patients, 1307 received a cranial CT scan. Four hundred eighty-nine patients (37.4%) with a mean age of 63.9 ± 22.8 years had evidence of an acute traumatic intracranial lesion on CT. Three patients (< 0.1%) were admitted to the intensive care unit for neurological observation and received oropharyngeal intubation. Seventeen patients (0.1%) underwent neurosurgical intervention. In 818 patients (62.6%), no evidence of an acute trauma-related lesion was found on CT. Data analysis showed that the presence of at least 1 of the following factors can predict the necessity of cranial CT: amnesia, GCS score, age > 65 years, loss of consciousness, nausea or vomiting, hypocoagulation, dementia or a history of ischemic stroke, anisocoria, skull fracture, and development of a focal neurological deficit. Patients requiring neurosurgical intervention were detected with a sensitivity of 90% and a specificity of 67% by using the authors' analysis. In contrast, the use of the CCHR in these patients detected the need for neurosurgical intervention with a sensitivity of only 80% and a specificity of 72%. Conclusions The use of the suggested parameters proved to be superior in the detection of high-risk patients who sustained a mild head trauma compared with the CCHR rules. Further validation of these results in a multicenter setting is needed. Clinical trial registration no.: NCT00451789 (ClinicalTrials.gov.)

Clinical decision rules for children with minor head injury: a systematic review

2011 ◽  
Vol 96 (5) ◽  
pp. 414-421 ◽  
Author(s):  
A. Pickering ◽  
S. Harnan ◽  
P. Fitzgerald ◽  
A. Pandor ◽  
S. Goodacre
Keyword(s):  
Systematic Review ◽  
Head Injury ◽  
Decision Rules ◽  
Clinical Decision ◽  
Minor Head Injury ◽  
Clinical Decision Rules

029 Clinical decision rules for children with minor head injury: a systematic review

2011 ◽  
Vol 28 (Suppl 1) ◽  
pp. A13-A13
Author(s):  
A. Pickering ◽  
S. Harnan ◽  
P. Fitzgerald ◽  
A. Pandor ◽  
S. Goodacre
Keyword(s):  
Systematic Review ◽  
Head Injury ◽  
Decision Rules ◽  
Clinical Decision ◽  
Minor Head Injury ◽  
Clinical Decision Rules

Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury

2020 ◽  
Vol 37 (3) ◽  
pp. 127-134 ◽  
Author(s):  
Amit Kochar ◽  
Meredith L Borland ◽  
Natalie Phillips ◽  
Sarah Dalton ◽  
John Alexander Cheek ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
Decision Rules ◽  
Secondary Analysis ◽  
Clinical Decision ◽  
Important Indicator ◽  
Coma Scale ◽  
Gcs Score

ObjectiveHead injury (HI) is a common presentation to emergency departments (EDs). The risk of clinically important traumatic brain injury (ciTBI) is low. We describe the relationship between Glasgow Coma Scale (GCS) scores at presentation and risk of ciTBI.MethodsPlanned secondary analysis of a prospective observational study of children<18 years who presented with HIs of any severity at 10 Australian/New Zealand centres. We reviewed all cases of ciTBI, with ORs (Odds Ratio) and their 95% CIs (Confidence Interval) calculated for risk of ciTBI based on GCS score. We used receiver operating characteristic (ROC) curves to determine the ability of total GCS score to discriminate ciTBI, mortality and need for neurosurgery.ResultsOf 20 137 evaluable patients with HI, 280 (1.3%) sustained a ciTBI. 82 (29.3%) patients underwent neurosurgery and 13 (4.6%) died. The odds of ciTBI increased steadily with falling GCS. Compared with GCS 15, odds of ciTBI was 17.5 (95% CI 12.4 to 24.6) times higher for GCS 14, and 484.5 (95% CI 289.8 to 809.7) times higher for GCS 3. The area under the ROC curve for the association between GCS and ciTBI was 0.79 (95% CI 0.77 to 0.82), for GCS and mortality 0.91 (95% CI 0.82 to 0.99) and for GCS and neurosurgery 0.88 (95% CI 0.83 to 0.92).ConclusionsOutside clinical decision rules, decreasing levels of GCS are an important indicator for increasing risk of ciTBI, neurosurgery and death. The level of GCS should drive clinician decision-making in terms of urgency of neurosurgical consultation and possible transfer to a higher level of care.

scholarly journals Canadian C-Spine Rule study for alert and stable trauma patients: I. Background and rationale

CJEM ◽  
2002 ◽  
Vol 4 (02) ◽  
pp. 84-90 ◽  
Author(s):  
Ian G. Stiell ◽  
George A. Wells ◽  
R. Douglas McKnight ◽  
Robert Brison ◽  
Howard Lesiuk ◽  
...  
Keyword(s):  
Decision Rules ◽  
Clinical Decision ◽  
Evidence Based ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
Clinical Decision Rule ◽  
Clinical Decision Rules ◽  
Ct Head ◽  
Cervical Spine Radiography ◽  
Evidence Based Guidelines

ABSTRACTThis paper is Part I of a 2-part series to describe the background and methodology for the Canadian C-Spine Rule study to develop a clinical decision rule for rational imaging in alert and stable trauma patients. Current use of radiography is inefficient and variable, in part because there has been a lack of evidence-based guidelines to assist emergency physicians. Clinical decision rules are research-based decision-making tools that incorporate 3 or more variables from the history, physical examination or simple tests. The Canadian CT Head and C-Spine (CCC) Study is a large collaborative effort to develop clinical decision rules for the use of CT head in minor head injury and for the use of cervical spine radiography in alert and stable trauma victims. Part I details the background and rationale for the development of the Canadian C-Spine Rule. Part II will describe in detail the objectives and methods of the Canadian C-Spine Rule study.

Applicability of the CATCH, CHALICE and PECARN paediatric head injury clinical decision rules: pilot data from a single Australian centre

2012 ◽  
Vol 30 (10) ◽  
pp. 790-794 ◽  
Author(s):  
Mark D Lyttle ◽  
John A Cheek ◽  
Carol Blackburn ◽  
Ed Oakley ◽  
Brenton Ward ◽  
...  
Keyword(s):  
Head Injury ◽  
Decision Rules ◽  
Clinical Decision ◽  
Clinical Decision Rules ◽  
Pilot Data ◽  
Paediatric Head Injury
Sign in / Sign up

Export Citation Format

Share Document