Skull X-Rays in Minor Head Injury

A retrospective review of the value of skull X-rays in the management of1379 patients presenting to an accident and emergency department with minor head injuries was made. Ten skull fractures were identified in this group (an incidence of 0.7%) of which only four were identified by the casualty officer, the remainder being subsequently identified by the radiologist. Some 90 per cent of patients had no history of concussion, and 33 per cent had no external evidence of head injury. All patients with fractures were admitted because of clinical criteria so that skull X-rays played no part in determining whether patients were admitted for observation or not. Only one patient required operative intervention for a compound depressed fracture, and no patient developed an intracranial haematoma. It is concluded that there is need to educate casualty officers on the indications for, and interpretation of skull X-rays. It is hoped that this might decrease the cost to the Health Service of needless skull X-rays, without detriment to the standards of patient care.

Download Full-text

Golf Related Head Injuries in Children: The Little Tigers

Scottish Medical Journal ◽

10.1177/003693309804300504 ◽

1998 ◽

Vol 43 (5) ◽

pp. 139-140 ◽

Cited By ~ 9

Author(s):

A.C. McGuffie ◽

M.O. Fitzpatrick ◽

D. Hall

Keyword(s):

Emergency Department ◽

Head Injury ◽

Emergency Departments ◽

Head Injuries ◽

Western Society ◽

Accident And Emergency ◽

Head Injured ◽

Accident And Emergency Department ◽

Injured Patients

Head injury is a major cause of morbidity in Western society and sport related incidents account for approximately 11% of all head injured patients attending Accident and Emergency Departments. 1 Golf was shown to be one of the sports most commonly associated with head injury requiring referral to a regional neurosurgical centre.2 Previous studies have demonstrated that it is predominantly children who sustain golf related head injuries which present either to an accident and emergency department3 or a regional neurosurgical centre.2 This study examines the number and pattern of golf related head injuries in children presenting to an accident and emergency department or requiring admission to the regional neurosurgical centre, over a three month period.

Download Full-text

Left-Sided Bochdalek's Hernia in a Young Adult: A Case Report and Literature Review

The Surgery Journal ◽

10.1055/s-0041-1731443 ◽

2021 ◽

Vol 07 (03) ◽

pp. e124-e126

Author(s):

Mark Portelli ◽

Mark Bugeja ◽

Charles Cini

Keyword(s):

Computed Tomography ◽

Young Adult ◽

Rare Case ◽

Surgical Repair ◽

Bochdalek Hernia ◽

Case Presentation ◽

Atypical Case ◽

Accident And Emergency ◽

History Of ◽

Accident And Emergency Department

Abstract Purpose Bochdalek's hernia is a type of congenital diaphragmatic hernia occurring secondary to a defect in the posterior attachment of diaphragm. This condition commonly presents with respiratory insufficiency in infants. To date, there are less than 100 cases of Bochdalek's hernia presenting in adults published in the literature. The mainstay treatment of Bochdalek's hernia involves reduction of hernial contents back into the peritoneal cavity with a tensionless graft repair closing the diaphragmatic defect. Case Presentation We present an atypical case of the Bochdalek hernia presenting in a previously healthy 16-year-old male who presented to the Accident and Emergency department with a 2-day history of dysphagia and loss of breath. The Bochdalek hernia was confirmed on computed tomography (CT) imaging and the patient underwent surgical repair with Gore-Tex mesh. Conclusion The report shows a rare case of the Bochdalek hernia in a young adult, successfully managed with a laparotomy.

Download Full-text

Use of an accident and emergency department observation ward in the management of head injury

British Journal of Surgery ◽

10.1002/bjs.1800800858 ◽

1993 ◽

Vol 80 (8) ◽

pp. 1079-1079 ◽

Cited By ~ 2

Author(s):

A. F. T. Brown ◽

G. J. Wilkes ◽

C. T. Myers ◽

R. E. Maclaren

Keyword(s):

Emergency Department ◽

Head Injury ◽

Accident And Emergency ◽

Accident And Emergency Department

Download Full-text

A Retrospective Review of Patients with Radiological Missed Fractures in an Emergency Department in Hong Kong

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790301000403 ◽

2003 ◽

Vol 10 (4) ◽

pp. 215-222 ◽

Cited By ~ 3

Author(s):

VCH Ng ◽

FL Lau

Keyword(s):

Emergency Department ◽

Management Plan ◽

Lower Limbs ◽

X Rays ◽

Accident And Emergency ◽

Assessment And Treatment ◽

Spinal Region ◽

Accident And Emergency Department ◽

Clinical Records ◽

Christian Hospital

Aim To review the clinical spectrum and outcome of radiological missed fractures in the Accident and Emergency Department of United Christian Hospital (UCH) in 2002. Method In UCH, radiologists report all X-Rays taken in the Accident and Emergency Department (AED) within 48 hours. The study period was from 1st January 2002 to 31st December 2002. AED notes, relevant clinical records and all X-rays of patients with suspected missed fractures as reported by radiologists were reviewed for information on clinical features, treatments and outcomes. Results A total of 286 cases of missed fractures were found. Fourteen (4.9%) involved the skull and maxillofacial region, 83 (29.0%) involved the chest region, 53 (18.5%) involved the spinal region, 72 (25.2%) involved the upper limbs and 64 (22.4%) involved the lower limbs. Of these 286 cases, 137 (47.9%) were followed up in AED, 90 (31.5%) were referred to specialist clinics for further management, 26 (9.1%) required admission to hospital for further assessment and treatment, and 33 (11.5%) defaulted follow up. Furthermore, 87 (30.4%) of these 286 missed fractures required a change in management plan: 3 missed fractures required operative intervention (internal fixation) and 84 missed fractures required some form of external immobilisation. This group of patient did not lodge any complaint or claim. Conclusion A&E doctors missed quite a number of fractures that might result in significant morbidity. However, a reporting system by radiologists within 48 hours from discharge can pick up all these missed fractures, and may prevent complaints and litigations.

Download Full-text

Impacted urethral stone presenting as urinary retention in a child

BMJ Case Reports ◽

10.1136/bcr-2020-235022 ◽

2021 ◽

Vol 14 (1) ◽

pp. e235022

Author(s):

Kelly Storm Hoffmann ◽

Alok Godse

Keyword(s):

Urinary Retention ◽

Urethral Catheter ◽

Calcium Oxalate Stone ◽

Accident And Emergency ◽

Urethral Catheterisation ◽

History Of ◽

Accident And Emergency Department ◽

Urethral Stone ◽

Definitive Management

A seven-year-old boy was referred to our Accident and Emergency department with a history of urinary retention secondary to urinary tract infection and an inability to pass a urethral catheter. He had been treated a month before for suspected pyelonephritis by the referring hospital. Attempts at urethral catheterisation failed, and he was taken to theatre for cystourethroscopy and catheter placement. At this time, an impacted urethral stone was discovered. Because it could not be dislodged, a suprapubic catheter was placed, and the child was brought back at a later date for definitive management. Investigations revealed a pure calcium oxalate stone that was secondary in origin. There has been no recurrence during a follow-up period of 6 months.This illustrates that while rare, urethral stones do occur in children and should be considered in children presenting with urinary retention, haematuria and/or abdominal pain.

Download Full-text

Mitigating the Consequences of Subconcussive Head Injuries

Annual Review of Biomedical Engineering ◽

10.1146/annurev-bioeng-091219-053447 ◽

2020 ◽

Vol 22 (1) ◽

pp. 387-407

Author(s):

Eric A. Nauman ◽

Thomas M. Talavage ◽

Paul S. Auerbach

Keyword(s):

Head Injury ◽

Clinical Diagnosis ◽

Head Injuries ◽

Tissue Level ◽

Clinical Neurology ◽

Subconcussive Injury ◽

History Of ◽

Tissue Alteration ◽

The Brain

Subconcussive head injury represents a pathophysiology that spans the expertise of both clinical neurology and biomechanical engineering. From both viewpoints, the terms injury and damage, presented without qualifiers, are synonymously taken to mean a tissue alteration that may be recoverable. For clinicians, concussion is evolving from a purely clinical diagnosis to one that requires objective measurement, to be achieved by biomedical engineers. Subconcussive injury is defined as subclinical pathophysiology in which underlying cellular- or tissue-level damage (here, to the brain) is not severe enough to present readily observable symptoms. Our concern is not whether an individual has a (clinically diagnosed) concussion, but rather, how much accumulative damage an individual can tolerate before they will experience long-term deficit(s) in neurological health. This concern leads us to look for the history of damage-inducing events, while evaluating multiple approaches for avoiding injury through reduction or prevention of the associated mechanically induced damage.

Download Full-text

Beware of the Anticoagulated Elderly with Minor Head Injury

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790501200202 ◽

2005 ◽

Vol 12 (2) ◽

pp. 108-111

Author(s):

CH Chung

Keyword(s):

Head Injury ◽

Subdural Haematoma ◽

The Elderly ◽

Minor Head Injury ◽

Loss Of Consciousness ◽

X Rays ◽

Acute Subdural Haematoma ◽

History Of ◽

The Right ◽

Burr Holes

A 69-year-old man first presented to the emergency department after a fall. He had no history of loss of consciousness or vomiting. He sustained a 3 cm long laceration over the right occipital region of the head. There was no fracture in the X-rays of the skull. He was on warfarin because of cardiac problem. He was discharged after suturing. He re-attended the next morning because of left sided weakness. Non-contrast brain computed tomogram showed acute subdural haematoma. Burr holes were performed subsequently. Special precautions should be undertaken in managing the elderly with minor head injury, with a lower threshold for computed tomography and coagulation profile studies.

Download Full-text