How Often Do We Miss Serious Causes of Headache and Back Pain?
In patients presenting to the ED with headache or back pain, very few return with serious, missed diagnoses after the initial evaluation. Patient who are elderly, immunocompromised, or have preexisting neurologic disease were at greater risk of missing serious conditions.
Ottawa Rule for SAH
The application of the Ottawa SAH rule in this relatively small sample of patients had a 100% sensitivity for identifying SAH in the ED but a lower 95% confidence interval of 78.2. The 100% negative predictive value, with a promising 95% CI of 98.6-100%, may have been driven by the lower prevalence of SAH in this study population compared to a previous validation study.
Delay PREDICTs Problems in Pediatric TBI
The prevalence of traumatic brain injury (TBI) on CT in children with head injury presenting > 24 hours post-injury was 3.8%. Predictors on TBI on CT were suspicion of depressed skull fracture and non-frontal scalp hematoma.
Clearing the Pediatric C-Spine
This expert panel came up with a comprehensive algorithm to clear the c-spine in children with trauma.
Review – Endovascular Stroke Treatment
Endovascular therapy (EVT) for acute ischemic stroke can dramatically improve outcome. This review helps us makes sense of the trials on this topic.
Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage
The table below summarizes the recommendations for adult patients on anti-thrombotic agents with intracranial hemorrhage (both spontaneous and traumatic). This will be focused on ED management.
Pediatric TBI Guidelines from the CDC
Taking care of children with mild traumatic brain injury is not easy. This guideline states clearly, based on compiled evidence, what you should and should not do. It’s helpful.
Distracting Injury and C-Spine Clearance
Clinical clearance of the c-spine missed an equal number of c-spine injuries on CT (10-13%) whether distracting injury (DI) was present or not.
Which Head Injury Rule for Adults – CHIP, New Orleans, Canadian, NICE?
The CHIP rule performed better than other head injury rules in patients >16 years old in striking the balance between avoiding CT in 21% of patients while missing only 2 potential neurosurgical lesions on CT.
Spinal Motion Restriction Guidelines
The American College of Surgeons Committee on Trauma, American College of Emergency Physicians, and the National Association of EMS Physicians have offered a joint consensus statement on spinal motion restriction in trauma patients.