Scan ‘Em All – Anticoagulated Minor Head Trauma
Incidence of intracerebral hemorrhage (ICH) on CT following minor head trauma in anticoagulated patients was 9%, which means we have to CT all these people.
Head Ultrasound Can’t Screen for Trauma in Infants
Head ultrasound (HUS) via open fontanelle was a poor screening tool for intracranial bleed due to accidental or inflicted trauma.
New CATCH2 Highly Sensitive for Pediatric Brain Injury
CATCH2 is the CATCH rule plus ≥4 episodes of vomiting. It was highly sensitive for neurosurgical intervention and predicting injury on CT.
Timing of Stroke After Blunt Cerebrovascular Dissection
Most strokes from blunt cerebrovascular injury (BCVI) occurred at a median time of 48 hours. If other injuries allow it, the earlier antithrombotic therapy can be started, the better for preventing stroke.
Atraumatic Needles Drastically Reduce Post-LP Headache
In this large meta-analysis of 110 RCTs, the incidence of post-dural puncture headache (PDPH) was only 4.2% compared to conventional LP needles at 11%; NNT = 14. This is a game-changer.
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.
Value of “Red Flag” Questions for Back Pain
Positive responses to "red flag" screening questions for back pain warranted further investigation, though the positive predictive value was poor. Negative responses to screening "red flag" questions were useless as a screening tool for ruling out serious disease, such as fracture, infection, malignancy, or cauda equina.
ICH in NOAC vs Warfarin and Mortality
Among patients with ICH, those on non-vitamin K oral anticoagulants had a lower in-hospital risk of mortality compared to warfarin (26.5% vs 32.6%). Compared to warfarin, those on NOACs were more likely to be discharged home (+3.3%), be functionally independent (+2.5%), and have the ability to ambulate independently at discharge (+1.8%).
No Spine Immobilization in Penetrating Trauma per EAST
EAST concluded spine immobilization in penetrating trauma is unnecessary and associated with an increase in mortality.