Pediatric TBI Guidelines from the CDC

Pediatric TBI Guidelines from the CDC

Taking care of children with mild traumatic brain injury is not easy. This guideline states clearly, based on compiled evidence, what you should and should not do.  It’s helpful.

Which Head Injury Rule for Adults - CHIP, New Orleans, Canadian, NICE?

Which Head Injury Rule for Adults - CHIP, New Orleans, Canadian, NICE?

The CHIP rule performed better than other head injury rules in patients >16 years old in striking the balance between avoiding CT in 21% of patients while missing only 2 potential neurosurgical lesions on CT.

LRINEC Score, Physical Exam, or Imaging for Necrotizing Infection?

LRINEC Score, Physical Exam, or Imaging for Necrotizing Infection?

In this systematic review and meta-analysis, no single aspect of the physical examination, imaging, or LRINEC score had high enough sensitivity to exclude necrotizing soft tissue infections. Contrast CT performed the best, but it was only 94.3% sensitive at best. If you have a high clinical suspicion, early surgical consultation is necessary for definitive diagnosis and management.

A New Way to Dimer?

A New Way to Dimer?

In this retrospective review, age-adjusted, clinical probability-adjusted, and standard D-dimer approaches had similar NPVs (99.7%, 99.1%, 100% respectively). Clinical probability-adjusted D-dimer has potential to exclude PE in more patients without imaging, but use caution before applying this to practice until prospectively validated.

Scan 'Em All - Anticoagulated Minor Head Trauma

Scan 'Em All - Anticoagulated Minor Head Trauma

Incidence of intracerebral hemorrhage (ICH) on CT following minor head trauma in anticoagulated patients was 9%, which means we have to CT all these people.

Does Negative CTPA Rule Out High Pretest Probability PE?

Does Negative CTPA Rule Out High Pretest Probability PE?

For patients with high pretest probability for pulmonary embolism, a negative CT pulmonary angiography alone does not appear to adequately rule out venous thromboembolism.

MRI-Guided Alteplase for Wake-Up Stroke

MRI-Guided Alteplase for Wake-Up Stroke

For patients with unknown time of stroke onset, MRI characteristics may be able to discern the timing of the stroke and allow for thrombolytic therapy.  Overall, outcomes were better with thrombolysis but at the possible cost of higher mortality and risk of intracranial bleed.

Does Pan-Scan Benefit Pediatric Trauma Patients?

Does Pan-Scan Benefit Pediatric Trauma Patients?

Whole body CT vs selective CT in children with trauma did not result in mortality benefit.  This large, retrospective study with propensity matching suggested that any additional injuries found on pan-CT may have been either not life-threatening or did not change management to produce mortality benefit.

Pediatric Head CT - Does Vomiting Matter?

Pediatric Head CT - Does Vomiting Matter?

In pediatric patients with blunt traumatic head injury, none had clinically important traumatic brain injury or significant injury on CT if the only symptom was vomiting <3 times.  It was still extremely low if isolated vomiting 3 or more times: 3/1000 for ciTBI and 6/1000 for TBI-CT.

The Next PECARN Rule? - NEXUS II CT Rule for Kids

The Next PECARN Rule? - NEXUS II CT Rule for Kids

The NEXUS II Pediatric Head CT Decision Instrument was 100% sensitive for ruling out children with a neurosurgical outcome, but it was relatively small and had wide confidence intervals.  I don't think this will supplant PECARN.

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