Being Safe with SDH – The SafeSDH Tool
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The SafeSDH prediction tool can help to identify patients with subdural hematoma (SDH) who may not necessitate a higher level of care (either ICU stay or interfacility transfer) and can safely be monitored in the community or lower acuity setting.
Source
External Validation of a Tool to Identify Low-Risk Patients With Isolated Subdural Hematoma and Preserved Consciousness. Ann Emerg Med. 2024 May;83(5):421-431. doi: 10.1016/j.annemergmed.2023.08.481. Epub 2023 Sep 19. PMID: 37725019.
What a Headache – Diagnostic Trends in SAH
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This retrospective cohort study of Kaiser NorCal EDs found increasing use of CT cerebral angiography for spontaneous subarachnoid hemorrhage diagnosis to be associated with fewer lumbar punctures and higher detection of unruptured intracranial aneurysms, with no significant change in the miss rate for SAH or bacterial meningitis.
Source
Shifts in Diagnostic Testing for Headache in the Emergency Department, 2015 to 2021. JAMA Netw Open. 2024 Apr 1;7(4):e247373. doi: 10.1001/jamanetworkopen.2024.7373. PMID: 38639937; PMCID: PMC11031686.
New Guidelines for Mild Pediatric TBI
Exciting news! JournalFeed and Dr. Amal Mattu's Top Picks Video Series is set to GO LIVE next week! It's free for Gold Spoon members or you can just get the video series. Watch this trailer and get excited!
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In this systematic review, authors identified clinical practice guideline (CPG) recommendations with moderate to high quality evidence that can be used by the ED practitioner to help in the care of pediatric patients with mild traumatic brain injury (mTBI).
Source
Clinical Practice Guideline Recommendations in Pediatric Mild Traumatic Brain Injury: A Systematic Review. Ann Emerg Med. 2023 Dec 22:S0196-0644(23)01381-1. doi: 10.1016/j.annemergmed.2023.11.012. Epub ahead of print.
Ketamine vs Etomidate in TBI – Prehospital Version
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Patients with TBI who were intubated in the prehospital setting had no difference in 30-day mortality when comparing induction with ketamine versus etomidate.
Source
Etomidate versus Ketamine as prehospital induction agent in patients with suspected severe traumatic brain injury. Anesthesiology. 2024. Jan 8. Doi: 10.1097/ALN.0000000000004894. Online ahead of print.
Cauda Equina Syndrome – Spoon-Feed Version
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Cauda equina syndrome (CES) is a spinal emergency. This is a practical guide for diagnosis and management as well as review of recent literature published on the topic.
New ACEP Clinical Policy on Mild TBI
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ACEP has issued an updated Clinical Policy to provide evidence-based guidelines for management of adult patients presenting to the ED with mild traumatic brain injury based on systematic review of available literature.
Source
Clinical Policy: Critical Issues in Management of Adult Patients Presenting to the Emergency Department with Mild Traumatic Brain Injury. Ann Emerg Med. 2023 May; 81(5): e63-e105. doi: 10.1016/j.annemergmed.2023.01.014.
This Is BIG – New AAST Brain Injury Guidelines
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This article was a multi-institutional prospective validation of the American Association for Surgery of Trauma (AAST) Brain Injury Guidelines (BIG), which were developed to guide effective resource utilization for traumatic brain injury. The validation study demonstrated that this system was accurate and safe and that its implementation can reduce CT scan utilization and neurosurgical consultation.
Source
Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022 Aug 1;93(2):157-165. doi: 10.1097/TA.0000000000003554. Epub 2022 Mar 28.
New AHA SAH Guidelines – Spoon-Feed Version
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Aneurysmal subarachnoid hemorrhage (aSAH) is a deadly condition. Here’s a quick summary of the 40-page AHA/ASA evidence-based guidelines for diagnosis and management.
CT C-Spine Negative? Clear The Kid’s Collar
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In this large, single-institution retrospective review of pediatric blunt trauma patients, no clinically significant injuries (requiring operative intervention) were missed when using multi-detector CT scan as the imaging modality of choice.
Does Ketamine Raise ICP in Children with TBI?
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This retrospective study of thirty-three pediatric patients with severe traumatic brain injury (sTBI) demonstrated no increase in intracranial pressure (ICP) after administration of ketamine.
Source
Acute Effects of Ketamine on Intracranial Pressure in Children with Severe Traumatic Brain Injury. Crit Care Med. 2023 Feb 24; e005806 DOI: 10.1097