Head injury: Audit of a clinical guideline to justify head CT

2013 ◽  
Vol 57 (2) ◽  
pp. 161-168 ◽  
Author(s):  
Nicholas B Haydon
Keyword(s):  
Head Injury ◽  
Clinical Guideline ◽  
Head Ct

Akathisia after mild traumatic head injury

2010 ◽  
Vol 5 (5) ◽  
pp. 460-464 ◽  
Author(s):  
Atman Desai ◽  
David W. Nierenberg ◽  
Ann-Christine Duhaime
Keyword(s):  
Head Injury ◽  
Pediatric Patients ◽  
Single Administration ◽  
Clinical Context ◽  
Traumatic Head Injury ◽  
Head Ct ◽  
Acute Head Injury ◽  
Traumatic Head ◽  
Symptom Complex ◽  
Motor Restlessness

The authors describe the case of a 13-year-old boy who exhibited progressive disabling motor restlessness, torticollis, urinary symptoms, and confusion following a fall from a bicycle. The differential diagnosis of this striking symptom complex in this clinical context can be problematic. In this case, the symptoms ultimately appeared most consistent with severe akathisia resulting from a single administration of haloperidol used at an outside hospital to sedate the patient prior to a head CT scan. The literature on akathisia in pediatric patients, and especially in patients following acute head injury, is reviewed, with suggestions for an approach to these symptoms in this clinical setting.

scholarly journals Head injury on Warfarin: likelihood of delayed intracranial bleeding in patients with negative initial head CT

2018 ◽  
Vol 11 (1) ◽  
Author(s):  
Amer Afaneh ◽  
Jennifer Ford ◽  
Jenna Gharzeddine ◽  
Alexandre Mazar ◽  
R. David Hayward ◽  
...  
Keyword(s):  
Head Injury ◽  
Intracranial Bleeding ◽  
Head Ct

scholarly journals Reduction of paediatric head CT utilisation at a rural general hospital emergency department

2020 ◽  
Vol 29 (11) ◽  
pp. 912-920
Author(s):  
Jeffrey Paul Louie ◽  
Joseph Alfano ◽  
Thuy Nguyen-Tran ◽  
Hai Nguyen-Tran ◽  
Ryan Shanley ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Rural Community ◽  
Emergency Departments ◽  
Control Charts ◽  
Intervention Period ◽  
Head Ct ◽  
Pediatric Injury ◽  
Ct Utilization ◽  
Ct Head

BackgroundBlunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department.MethodsChildren presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts.ResultsThe preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation.ConclusionThe series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.

Necessity of monitoring after negative head CT in acute head injury

Injury ◽  
2014 ◽  
Vol 45 (9) ◽  
pp. 1340-1344 ◽  
Author(s):  
Harri Isokuortti ◽  
Teemu M. Luoto ◽  
Anneli Kataja ◽  
Antti Brander ◽  
Jari Siironen ◽  
...  
Keyword(s):  
Head Injury ◽  
Head Ct ◽  
Acute Head Injury

scholarly journals Serum S100B Levels Can Predict Computed Tomography Findings in Paediatric Patients with Mild Head Injury

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Fatos M. Kelmendi ◽  
Arsim A. Morina ◽  
Agon Y. Mekaj ◽  
Afrim Blyta ◽  
Ridvan Alimehmeti ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
S100b Protein ◽  
Mild Head Injury ◽  
Mild Tbi ◽  
Serum S100b ◽  
Head Ct ◽  
Protein Levels ◽  
Paediatric Patients ◽  
Cranial Injury

Introduction. Traumatic brain injuries (TBIs) are very common in paediatric populations, in which they are also a leading cause of death. Computed tomography (CT) overuse in these populations results in ionization radiation exposure, which can lead to lethal malignancies. The aims of this study were to investigate the accuracy of serum S100B levels with respect to the detection of cranial injury in children with mild TBI and to determine whether decisions regarding the performance of CT can be made based on biomarker levels alone. Materials and Methods. This was a single-center prospective cohort study that was carried out from December 2016 to December 2017. A total of 80 children with mild TBI who met the inclusion criteria were included in the study. The patients were between 2 and 16 years of age. We determined S100B protein levels and performed head CTs in all the patients. Results. Patients with cranial injury, as detected by CT, had higher S100B protein levels than those without cranial injury (p<0.0001). We found that patients with cranial injury (head CT+) had higher mean S100B protein levels (0.527 μg L−1, 95% confidence interval (CI) 0.447–0.607 μg L−1) than did patients without cranial injury (head CT−) (0.145 μg L−1, 95% CI 0.138–0.152 μg L−1). Receiver operating characteristic (ROC) curve analysis clearly showed that S100B protein levels differed between patients with and without cranial injury at 3 hours after TBI (AUC = 0.893, 95% CI 0.786–0.987, p=0.0001). Conclusion. Serum S100B levels cannot replace clinical examinations or CT as tools for identifying paediatric patients with mild head injury; however, serum S100B levels can be used to identify low-risk patients to prevent such patients from being exposed to radiation unnecessarily.

scholarly journals Clinical predictors of abnormal head computed tomography scan in patients who are conscious after head injury

2017 ◽  
Vol 08 (01) ◽  
pp. 064-067 ◽  
Author(s):  
Rakesh Kumar Mishra ◽  
Ashok Munivenkatappa ◽  
Vasuki Prathyusha ◽  
Dhaval P. Shukla ◽  
Bhagavatula Indira Devi
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Ct Scan ◽  
Clinical Features ◽  
Significant Risk ◽  
Observation Study ◽  
Head Ct ◽  
Abnormal Head ◽  
History Of ◽  
Head Computed Tomography

ABSTRACT Background: Indication of a head computed tomography (CT) scan in a patient who remains conscious after head injury is controversial. We aimed to determine the clinical features that are most likely to be associated with abnormal CT scan in patients with a history of head injury, and who are conscious at the time of presentation to casualty. Materials and Methods: This is a prospective observation study of patients presented to casualty with history of head injury, and who were conscious, i.e., Glasgow Coma Scale (GCS) 15 at the time of evaluation. All patients underwent head CT scan. The CT scan was reported as abnormal if it showed any pathology ascribed to trauma. The following variables were used: age, gender, mode of injury (road traffic accident, fall, assault, and others), duration since injury, and history of transient loss of consciousness, headache, vomiting, ear/nose bleeding, and seizures. Logistic regression analysis was used to identify the clinical features that predicted an abnormal CT scan. Results: During the observation period, a total of 1629 patients with head injury were evaluated, out of which 453 were in GCS 15. Abnormal CT scan was present in 195 (43%) patients. Among all the variables, the following were found significantly associated with abnormal CT scan: duration since injury (>12 h) P < 0.001; vomiting odds, ratio (OR) 1.89 (1.23, 2.80), P < 0.001; and presence of any symptom, OR 2.36 (1.52, 3.71), P < 0.001. Conclusion: A patient with GCS 15 presenting after 12 hours of injury with vomiting or combination of symptoms has a significant risk of abnormal head CT scan.

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