Paired Head/C-Spine CT Low Yield
Paired head and c-spine CT scans had low yield for detecting clinically significant injury (CSI) on both, 0.5%. This suggests a selective scanning, rather than a shotgun approach, may be better.
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?
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.
Isolated Costal Margin Tenderness in Kids – CT or Not?
Pediatric patients with isolated costal margin tenderness (CMT) on exam are very unlikely to have underlying intra-abdominal injury and also unlikely to benefit from CT. But make sure there are no other signs of abdominal injury.
Is a Blood Culture Needed in Cellulitis?
Blood cultures were low yield in patients admitted with cellulitis, and should largely be avoided. Similarly, imaging was also low yield but changed management in a minority of cases.
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 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.
CT and Discharge Abdominal Stab Wounds?
Nine percent of patients with negative CT for anterior abdominal stab wound (AASW) subsequently required surgery. Negative CT for AASW was inadequate to consider patients safe for immediate discharge.
DEFUSE 3 – A New DAWN in Extending the Stroke Window?
Patients beyond the 6-hour invasive stroke treatment window benefitted from endovascular treatment of proximal MCA or ICA occlusion up to 16 hours from onset if there was a large ischemic penumbra on perfusion imaging that had not yet infarcted.
Contrast Nephropathy Is Real
There are good data to support contrast-associated acute kidney injury (CA-AKI). With the use of low osmolar contrast agents, the risk may be lower. However, none of the myth-busting studies are good enough to exclude the risk of CA-AKI, especially in the most vulnerable patients.