Most younger children 5-7 years old recover from concussion within 2 weeks. More than 80% of children 8-12 years old and boys 13-18 years old recover within 4 weeks. Most teen girls had not recovered by week 12.

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.

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.

Although opioids are not first-line treatment for ankle sprains, an opioid was prescribed for 25% of emergency department patients diagnosed with an isolated ankle sprain. Prescribing varied widely among states. Additionally, patients prescribe greater quantities of opioids were more likely to transition to continued use.

The incidence of suicide nearly doubled in patients who had traumatic brain injury (TBI) compared to baseline.  Risk increased with severity of injury, number of visits, and was highest in the first 6 months post-injury.

We have much room for improvement in educating patients with mild traumatic brain injury (TBI) who are discharged from the ED on the importance of outpatient follow up.

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 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.

Opioids were no better than non-opioid medicines for chronic back, hip, or knee pain. However, undesirable medication-related symptoms occurred more commonly among those taking opioids. 

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.