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.
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.
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.
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.