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At least in the initial period, there appears to be no clinically meaningful difference in IQ scores in pediatric patients after a concussion.
Source
IQ After Pediatric Concussion. Pediatrics. 2023. 152(2);e2022060515. https://doi.org/10.1542/peds.2022-060515.
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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.
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Post-concussion return to functional baseline occurs early for symptoms, balance, and mental status along with partial neurocognitive functioning. Visual-memory and reaction-time recovery, however, lag behind the other groups post-concussion.
Source
Time to Recovery as Measured on Clinical Assessments after Sport-Related Concussion. N Engl J Med. 2023 May 4;388(18):1717-1719. doi: 10.1056/NEJMc2301706.
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The GRACE-3 group (SAEM) provides us with a guideline based on their review we covered previously with the evidence for evaluating and managing adult patients presenting to emergency departments for acute dizziness. Emergency clinicians need additional training in physical exam techniques related to acute dizziness in order to perform them effectively, which should be a specialty-wide goal for the future.
Source
Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3): Acute dizziness and vertigo in the emergency department. Acad Emerg Med. 2023 May;30(5):442-486. doi: 10.1111/acem.14728.
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Tenecteplase was non-inferior to alteplase in patients with acute ischemic stroke who were eligible for intravenous thrombolytic therapy but ineligible or refused endovascular thrombectomy.
Source
Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial. Lancet. 2023 Feb 8;S0140-6736(22)02600-9. doi: 10.1016/S0140-6736(22)02600-9. Online ahead of print.
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This study supports the notion that an early return to school (RTS), results in faster recovery from concussion symptoms versus prolonged absences.
Source
Association Between Early Return to School Following Acute Concussion and Symptom Burden at 2 Weeks Postinjury. JAMA Netw Open. 2023 Jan 3;6(1):e2251839. doi: 10.1001/jamanetworkopen.2022.51839.
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After a training session, both interns and senior emergency providers (EPs) could accurately distinguish between central and peripheral vertigo using the 4-step STANDING algorithm.
Source
Effectiveness and reliability of the 4-step STANDING algorithm performed by emergency interns and seniors for predicting central causes of vertigo. Acad Emerg Med. 2023 Jan 11. doi: 10.1111/acem.14659. Online ahead of print.
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A general neurological exam has low sensitivity but high specificity for stroke in acute dizziness or vertigo. No modality is more sensitive than a HINTS exam by a trained provider.
Source
Diagnostic accuracy of the physical exam in emergency department patients with acute vertigo or dizziness: Systematic review and meta-analysis for GRACE-3. Acad Emerg Med. 2022 Dec 1. doi: 10.1111/acem.14630. Online ahead of print.
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Non-contrasted multislice CT (MSCT) is known to be highly sensitive in detecting subarachnoid hemorrhage (SAH) when performed within 6 hours of headache onset. Now, with modern MSCT, it looks like we can safely extend the timeframe even more.
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Vestibular suppressant medications in peripheral vertigo were not associated with symptom resolution, decrease in repeat ED visits, patient satisfaction, or increased quality of life. The authors suggest that positional maneuvers, such as the Epley maneuver, should be the primary treatment for BPPV.
Source
Vestibular suppressants for benign paroxysmal positional vertigo: A systematic review and meta-analysis of randomized controlled trials. Acad Emerg Med. 2022 Oct 21. doi: 10.1111/acem.14608. Online ahead of print.
