Patients with Blunt Head Trauma on Anticoagulation and Antiplatelet Medications: Can They be Safely Discharged after a Normal Initial Cranial Computed Tomography Scan?

2014 ◽  
Vol 80 (6) ◽  
pp. 610-613 ◽  
Author(s):  
Salvatore Docimo ◽  
Aleksandr Demin ◽  
Fausto Vinces
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Head Trauma ◽  
International Normalized Ratio ◽  
Cranial Computed Tomography ◽  
Mechanism Of Injury ◽  
Computed Tomography Scan ◽  
Cranial Ct ◽  
Blunt Head Trauma ◽  
Tomography Scan

The literature reports delayed intracranial hemorrhage (ICH) after blunt trauma in patients taking preinjury anticoagulant and antiplatelet (AC/AP) medications. We sought to evaluate the incidence of delayed ICH at our institution and hypothesize that patients taking AC/AP medications who are found to have a negative first computed tomography (CT) scan will not require a second CT scan. A total of 303 patients were retrospectively reviewed. Age, gender, mechanism of injury, international normalized ratio (INR), initial and secondary cranial CT findings, and outcomes were recorded. One hundred sixty-eight (55.4%) were found to be taking AP/AC medications. Ninety-six (57%) were male and 72 (43%) female. Aspirin use was 42.8 per cent (72 of 168), clopidogrel next (39 of 168 [23.0%]), and warfarin least (18 of 168 [10.7%]). One hundred sixty-six (98.8%) presented with significant findings on the first CT scan. Fourteen (87.5%) of the 16 patients with an INR 2.0 or higher presented with an ICH on the first CT. Ninety percent of patients with an INR 1.5 or higher presented with positive findings on the first CT scan. One hundred per cent of patients with an INR 3.0 or higher presented with an ICH on the first CT scan. The incidence of a delayed ICH was two of 168 (1.19%). Of those two patients with a delayed ICH, 100 per cent were taking warfarin and had an INR greater than 2.0. The incidence of delayed ICH was 1.19 per cent. The protocol requiring a second CT scan for all patients on AC/AP medications after a negative first CT scan should be questioned. For patients with blunt head trauma taking warfarin or a warfarin–aspirin combination, a repeat cranial CT scan after a negative initial CT is acceptable. For patients taking clopidogrel, a period of observation may be warranted.

Do Children With Blunt Head Trauma and Normal Cranial Computed Tomography Scan Results Require Hospitalization for Neurologic Observation?

2011 ◽  
Vol 58 (4) ◽  
pp. 315-322 ◽  
Author(s):  
James F. Holmes ◽  
Dominic A. Borgialli ◽  
Frances M. Nadel ◽  
Kimberly S. Quayle ◽  
Neil Schambam ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Head Trauma ◽  
Cranial Computed Tomography ◽  
Computed Tomography Scan ◽  
Blunt Head Trauma ◽  
Tomography Scan

scholarly journals Cranial computed tomography scan findings in head trauma patients in Enugu, Nigeria

2011 ◽  
Vol 2 (1) ◽  
pp. 182 ◽  
Author(s):  
SamuelC Ohaegbulam ◽  
ChikaA Ndubuisi ◽  
ChinenyeO Ani ◽  
WilfredC Mezue ◽  
UwadiegwuA Erechukwu
Keyword(s):  
Computed Tomography ◽  
Head Trauma ◽  
Cranial Computed Tomography ◽  
Trauma Patients ◽  
Computed Tomography Scan ◽  
Tomography Scan

scholarly journals Development, Evaluation and Implementation of Chief Complaint Groupings to Activate Data Collection

2015 ◽  
Vol 06 (03) ◽  
pp. 521-535 ◽  
Author(s):  
L. Bajaj ◽  
J. Hoffman ◽  
E. Alessandrini ◽  
D. W. Ballard ◽  
R. Norris ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Trial ◽  
Data Collection ◽  
Head Trauma ◽  
High Sensitivity ◽  
Clinical Decision ◽  
Chief Complaint ◽  
Cranial Computed Tomography ◽  
Blunt Head Trauma ◽  
Development Evaluation

SummaryBackground: Overuse of cranial computed tomography scans in children with blunt head trauma unnecessarily exposes them to radiation. The Pediatric Emergency Care Applied Research Network (PECARN) blunt head trauma prediction rules identify children who do not require a computed tomography scan. Electronic health record (EHR) based clinical decision support (CDS) may effectively implement these rules but must only be provided for appropriate patients in order to minimize excessive alerts.Objective: To develop, implement and evaluate site-specific groupings of chief complaints (CC) that accurately identify children with head trauma, in order to activate data collection in an EHR.Methods: As part of a 13 site clinical trial comparing cranial computed tomography use before and after implementation of CDS, four PECARN sites centrally developed and locally implemented CC groupings to trigger a clinical trial alert (CTA) to facilitate the completion of an emergency department head trauma data collection template. We tested and chose CC groupings to attain high sensitivity while maintaining at least moderate specificity.Results: Due to variability in CCs available, identical groupings across sites were not possible. We noted substantial variability in the sensitivity and specificity of seemingly similar CC groupings between sites. The implemented CC groupings had sensitivities greater than 90% with specificities between 75–89%. During the trial, formal testing and provider feedback led to tailoring of the CC groupings at some sites.Conclusion: CC groupings can be successfully developed and implemented across multiple sites to accurately identify patients who should have a CTA triggered to facilitate EHR data collection. However, CC groupings will necessarily vary in order to attain high sensitivity and moderate-to-high specificity. In future trials, the balance between sensitivity and specificity should be considered based on the nature of the clinical condition, including prevalence and morbidity, in addition to the goals of the intervention being considered.Citation: Deakyne SJ, Bajaj L, Hoffmann J, Alessandrini E, Ballard DW, Norris R, Tzimenatos L, Swietlik M, Tham E, Grundmeier RW, Kuppermann N, Dayan PS. Development, Evaluation and Implementation of Chief Complaint Groupings to Activate Data Collection in a Multi-Center Study of Clinical Decision Support for Children with Head Trauma. Appl Clin Inform 2015; 6: 521–535http://dx.doi.org/10.4338/ACI-2015-02-RA-0019

scholarly journals Hubungan Antara Kadar DNA Plasma Virus Epstein Barr Dengan Stadium Klinis Karsinoma Nasofaring WHO Tipe 3

2019 ◽  
Vol 48 (2) ◽  
pp. 165
Author(s):  
Putranti Dyahayu Roziaty ◽  
Soehartono Soehartono ◽  
Hendradi Surjotomo
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Epstein Barr Virus ◽  
Tumor Type ◽  
Computed Tomography Scan ◽  
Cross Sectional ◽  
Barr Virus ◽  
Ebv Dna ◽  
Epstein Barr ◽  
Tomography Scan

Latar Belakang: Karsinoma nasofaring (KNF) merupakan keganasan yang tersering ditemukan, dan berdampak pada penurunan kualitas hidup serta memiliki mortalitas tinggi. Penanganan KNF selama ini terkendala oleh waktu tunggu yang cukup lama dalam menentukan staging KNF terutama untuk antrian pemeriksaan computed tomography scan (CT scan) dan Ultrasonography (USG). Pemeriksaan kadar DNA EBV (Deoxyribonucleic acid Epstein-Barr Virus) pada pasien yang relatif lebih mudah dan terjangkau dapat digunakan untuk memprediksi stadium dan prognosis KNF. Dengan mengetahui prognosis KNF lebih dini, maka diharapkan penanganan terhadap KNF dapat segera dilakukan. Tujuan: Mengetahui apakah kadar DNA EBV dapat dipakai untuk memprediksi stadium dan prognosis KNF dengan cara mencari hubungan antara kadar DNA EBV dengan stadium KNF. Metode: Penelitian cross sectional melibatkan 15 subjek penelitian yang terdiagnosis KNF WHO tipe 3 kemudian dilakukan staging dengan CT scan, USG abdomen, dan foto toraks, serta diambil sampel darah untuk diukur kadar DNA EBV. Hasil: Seluruh subjek penelitian mengalami peningkatan kadar DNA EBV sesuai dengan peningkatan stadium KNF. Peningkatan stadium KNF berhubungan signifikan dengan peningkatan kadar DNA EBV (p=0,001). Ukuran tumor (T) berhubungan signifikan dengan kadar DNA EBV (p=0,023), ukuran nodul (N) berhubungan signifikan dengan kadar DNA EBV (p=0,005), ada tidaknya metastasis tidak berhubungan signifikan dengan kadar DNA EBV (p=0,398). Nilai cut off kadar DNA EBV sebesar 952 kopi/ml. Kesimpulan: Terdapat hubungan yang signifikan antara kadar DNA EBV dengan stadium klinis, dengan demikian kadar DNA EBV dapat dipertimbangkan untuk digunakan sebagai prediktor stadium dan prognosis KNF. Background: Nasopharyngeal carcinoma (NPC) is the predominant tumor type arising in the nasopharynx,  with a high mortality and affecting quality of life.  NPC treatment  management is hindered by long queues of Computed Tomography Scan (CT scan) and Ultrasonography (USG) examinations to ascertain the NPC staging. The examination of Epstein-Barr Virus (EBV) DNA level is relatively simpler and inexpensive  to predict the NPC staging and prognosis, thus, it can speed up NPC treatment. Objective: To determine whether EBV DNA level can be used to predict the NPC  stage and prognosis by finding a correlation between EBV DNA level and NPC stage. Method: This was  a cross-sectional study involving 15 respondents who were diagnosed as WHO type 3 NPC, and examined by CT scan, abdominal ultrasound, chest X-ray,  and blood  test for measuring the levels of EBV DNA to determine the stage. Results: All respondents had elevated levels of EBV DNA in accordance with NPC stage elevation. Increased NPC stages were significantly correlated with elevated levels of EBV DNA (p=0.001). The size of tumor (T) was significantly correlated with EBV DNA (p=0.023), the size of nodule (N) was significantly correlated with EBV DNA (p=0.005).  The presence or absence of metastasis did not significantly correlate with EBV DNA (p=0.398). The EBV DNA cut off value was 952 copies/ml. Conclusions: There  was a significant correlation between EBV DNA levels and clinical stages, hence EBV DNA can be considered to be used as NPC staging and prognosis predictor.   

scholarly journals Anatomic Variations of the Nose in Chronic Rhinosinusitis: Correlation between Nasal Endoscopic and Computerized Tomography Scan Findings and a Review of Literature

2016 ◽  
Vol 9 (1) ◽  
pp. 13-17
Author(s):  
Priyanko Chakraborty ◽  
Rajiv K Jain ◽  
Purnima Joshi ◽  
Rakhi Kumari ◽  
Sidharth Pradhan
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Chronic Rhinosinusitis ◽  
Sinus Surgery ◽  
Anatomic Variations ◽  
Review Of Literature ◽  
Computed Tomography Scan ◽  
Diagnostic Endoscopy ◽  
The Mean ◽  
Tomography Scan

ABSTRACT Background Chronic rhinosinusitis (CRS) refers to a group of disorders characterized by inflammation of the mucosa of the paranasal sinuses. Nasal endoscopy and computed tomography (CT) scans are successfully used as diagnostic modalities of nose and paranasal sinus diseases. There have been many studies regarding the anatomic variations leading to pathogenesis of paranasal sinus diseases. Considerable progress has been made in the medical and surgical control of these conditions; however, a large number of questions relating to the diagnosis, evaluation, and treatment of the diseases remain unanswered. Materials and methods The study included 82 clinically diagnosed cases of CRS who underwent CT scan and were advised to undergo diagnostic endoscopy. The anatomical findings of the nose were compared to see correlation between nasal endoscopy and CT scan. Results The mean age (±standard error of the mean) of presentation was 34.11 (±1.42) years, while most patients were from the age group of 18 to 30 years. Males were predominating the study group with 62.2%, while 37.8% were females. The most common anatomic variation was deviated nasal septum with 92.68% CT reported patients. This was followed by inferior turbinate hypertrophy, septal spur, concha bullosa, and agger nasi cells. Conclusion Computed tomography scan is considered the gold standard for sinonasal imaging. Diagnostic endoscopy and CT scan are a must prior to any functional endoscopic sinus surgery. They help in assessing the extent of sinus disease and to know the variations and vital relations of the paranasal sinuses. Computed tomography scan assists the surgeon as a “road map” during endoscopic sinus surgery. How to cite this article Chakraborty P, Jain RK, Joshi P, Kumari R, Pradhan S. Anatomic Variations of the Nose in Chronic Rhinosinusitis: Correlation between Nasal Endoscopic and Computerized Tomography Scan Findings and a Review of Literature. Clin Rhinol An Int J 2016;9(1):13-17.

scholarly journals Determining Effective Dose on Computed Tomography Scan (CT SCAN) in Head Scanning

Natural-B ◽  
2011 ◽  
Vol 1 (1) ◽  
pp. 81-86
Author(s):  
Firdi Yuana ◽  
Kusharto Kusno ◽  
Achmad Hidayat
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Effective Dose ◽  
Computed Tomography Scan ◽  
Tomography Scan
Sign in / Sign up

Export Citation Format

Share Document