May 11 2021

LP After Delayed Head CT for SAH – Is It Required?

Neurology, Neurosurgery

Spoon Feed The sensitivity of a negative non-contrasted head CT performed to rule out atraumatic subarachnoid hemorrhage decreases when done >6 hours after headache onset, but further workup - including LP - requires shared decision making.

Mar 23 2021

GCS 8 – Intubate…Right?

Airway, Neurosurgery, Trauma

Spoon Feed Patients with isolated head trauma and GCS 7 or 8 had greater odds of mortality when intubated immediately. But this is not the study to override the GCS 8 = intubate dogma.

Feb 18 2021

ULTRA RCT – TXA for SAH?

Critical Care, Neurology, Neurosurgery, Pharmacy/Pharmacology

Spoon Feed ULTRA-early, short term IV TXA in patients with SAH with suspected aneurysm rupture did not improve clinical outcomes of patients as described by “good” (0-3) versus “poor” (4-6) modified Rankin Scale at 6 months.

Feb 17 2021

TXA for TBI – Meta-analysis of Nine RCTs

Neurosurgery, Pharmacy/Pharmacology, Trauma

Spoon Feed In patients with acute traumatic brain injury, tranexamic acid did not improve mortality or neurological outcome among survivors.

Jan 21 2021

TXA May Increase Mortality in TBI

EMS, Neurosurgery, Pharmacy/Pharmacology, Trauma

Spoon Feed TXA given in the prehospital setting for isolated traumatic brain injury was associated with increased 30-day mortality.

Nov 25 2020

Hypertonic Saline or Mannitol for Pediatric Increased ICP?

Critical Care, Infectious Disease, Neurosurgery, Pediatrics, Pharmacy/Pharmacology

Spoon Feed In children with CNS infections leading to increased ICP, treatment with hypertonic saline (3%) had better outcomes than 20% mannitol.

Oct 12 2020

Prehospital TXA for TBI – New RCT

Critical Care, Neurosurgery, Pharmacy/Pharmacology

Spoon Feed Prehospital TXA did not benefit patients with moderate to severe traumatic brain injury.

Jul 13 2020

Universal Screening for Blunt Cerebrovascular Injury?

Imaging, Neurosurgery, Trauma

Spoon Feed Clinical decision tools had poor diagnostic accuracy compared with universal CTA for blunt cerebrovascular injury (BCVI). Up to 23% of serious injuries may have been missed without universal screening.

Apr 21 2020

Who Needs CT? Aspirin, Clopidogrel, Warfarin, or a Combination?

Hematology/Oncology, Imaging, Neurosurgery, Pharmacy/Pharmacology, Trauma

Spoon Feed Patients taking warfarin or dual aspirin/clopidogrel therapy were at greater risk for significant intracranial injury on CT. Scan these folks.

Apr 20 2020

Blunt Cerebrovascular Injury – When to CTA

Imaging, Neurosurgery, Pharmacy/Pharmacology, Stroke, Trauma

Spoon Feed Use a screening protocol to determine which trauma patients to order CTA of the head and neck. It detects more blunt cerebrovascular injuries, which leads to more treatment, which reduces risk or stroke and mortality.