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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.

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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.

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In this prospective observational study of patients undergoing CT imaging of the abdomen/pelvis for blunt trauma, gestalt among Emergency Medicine residents/attendings and General Surgery residents was moderately accurate but not sufficiently sensitive to rule out clinically significant injuries when the acceptable miss rate was set at 2%.

Source
Accuracy of physician gestalt in prediction of significant abdominal and pelvic injury in adult blunt trauma patients [published online ahead of print, 2023 Jun 26]. Acad Emerg Med. 2023;10.1111/acem.14768. doi:10.1111/acem.14768.

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A full-body CT protocol in resuscitated adults with out of hospital cardiac arrest (OHCA) more often - and more quickly - found the cause of arrest than standard of care CT but did not improve neurologically intact survival.

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Computed tomography (CT) after out-of-hospital cardiac arrest (OHCA) often identifies clinically important pathology such as the etiology of the arrest, traumatic injuries from resuscitation, and consequences from inadequate perfusion.

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Diagnostic yield of computed tomography after non-traumatic out-of-hospital cardiac arrest. Resuscitation. 2023 Aug;189:109898. doi: 10.1016/j.resuscitation.2023.109898. Epub 2023 Jul 6.

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This ACEP clinical policy covers issues in the evaluating and managing ED patients with suspected appendicitis including clinical prediction rules, comparative imaging modalities, and need for IV contrast in CT imaging.

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Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Appendicitis: Approved by ACEP Board of Directors February 1, 2023. Ann Emerg Med. 2023 Jun;81(6):e115-e152. doi: 10.1016/j.annemergmed.2023.01.015.

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There is no association of doxycycline and tooth staining in children under 8 when used at usual dose and duration.

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Antibiotic Exposure and Dental Health: A Systematic Review. Pediatrics. 2023 Jun 2;e2023061350. doi: 10.1542/peds.2023-061350. Online ahead of print.

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In a meta-analysis of 1,685 patients with suspected scaphoid fracture after negative plain radiographs, no clinical feature adequately rules out occult fracture.   

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This database review of pediatric head trauma patients who had CT identified GCS 3-8 as an exam finding associated with intracranial hemorrhage (ICH); age, gender, and GCS were also associated with facial or skull fracture. It also found significant imaging results may exist in PECARN-negative patients.

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Risk Factors Associated with Traumatic Brain Injury and Implementation of Guidelines for Requesting Computed Tomography After Head Trauma Among Children in France. JAMA Netw Open. 2023 May 1;6(5):e2311092. doi: 10.1001/jamanetworkopen.2023.11092.

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Asymptomatic contact children of patients presenting with physical abuse are a vulnerable population who should be screened for traumatic injuries. This report details guidelines for radiologic screening.

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This systematic review found that the prevalence of cervical spine injuries in patients 65 years or older after a ground level or low-level fall was between 3.8-4.1%.

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Cervical spine injuries in adults ≥ 65 years after low-level falls - A systematic review and meta-analysis. Am J Emerg Med. 2023 May;67:144-155. doi: 10.1016/j.ajem.2023.02.008. Epub 2023 Feb 10.