Atraumatic Needles Drastically Reduce Post-LP Headache

Atraumatic Needles Drastically Reduce Post-LP Headache

In this large meta-analysis of 110 RCTs, the incidence of post-dural puncture headache (PDPH) was only 4.2% compared to conventional LP needles at 11%; NNT = 14.  This is a game-changer.

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.

Value of "Red Flag" Questions for Back Pain

Value of "Red Flag" Questions for Back Pain

Positive responses to "red flag" screening questions for back pain warranted further investigation, though the positive predictive value was poor.  Negative responses to screening "red flag" questions were useless as a screening tool for ruling out serious disease, such as fracture, infection, malignancy, or cauda equina.

ICH in NOAC vs Warfarin and Mortality

ICH in NOAC vs Warfarin and Mortality

Among patients with ICH, those on non-vitamin K oral anticoagulants had a lower in-hospital risk of mortality compared to warfarin (26.5% vs 32.6%). Compared to warfarin, those on NOACs were more likely to be discharged home (+3.3%), be functionally independent (+2.5%), and have the ability to ambulate independently at discharge (+1.8%).

Delayed Endovascular Stroke Treatment - Beyond the 6-hour Window

Delayed Endovascular Stroke Treatment - Beyond the 6-hour Window

Patients with acute stroke from occluded intracranial internal carotid artery (ICA) or proximal middle cerebral artery (MCA) presenting from 6-24 hours from onset benefitted from endovascular thrombectomy when clinical deficits of stroke were greater than expected based on infarct volume on diffusion-weighted MRI or perfusion CT.

Canadian CT Head Rule to Reduce CT Use

Canadian CT Head Rule to Reduce CT Use

The Canadian CT Head Rule was 100% sensitive for ruling out clinically important brain injury.  It had higher specificity than the New Orleans Criteria, which meant fewer people would need a CT scan by using the Canadian rule.

DOAC vs Warfarin Related Non-Traumatic ICH

DOAC vs Warfarin Related Non-Traumatic ICH

Compared with vitamin K antagonist (VKA)-related non-traumatic intracerebral hemorrhage (ICH), direct oral anticoagulant (DOAC)-related ICH had less disability, smaller bleeds, and the meta-analysis showed lower in-hospital mortality rates.

Clearing Drunk C-spines

Clearing Drunk C-spines

A negative c-spine CT had 99.9% NPV for clinically significant c-spine injury in intoxicated patients.  The Western Trauma Association recommends c-spine clearance, even in intoxicated patients, if gross motor function is normal, no neurologic complaints, and negative c-spine CT per experienced radiologist.  Be careful out there, and get institutional buy-in if you plan to put this into practice.

Member Login
Welcome, (First Name)!

Forgot? Show
Log In
Enter Member Area
My Profile Sign up to get full access. Log Out