scholarly journals The use of CT in the management of minor head injuries in Queenstown

2017 ◽  
Vol 9 (2) ◽  
pp. 162 ◽  
Author(s):  
Jennifer Keys ◽  
Louise Venter ◽  
Garry Nixon
Keyword(s):  
New Zealand ◽  
Head Injury ◽  
District Hospital ◽  
Head Injuries ◽  
Ct Scanning ◽  
Primary Diagnosis ◽  
Minor Head Injury ◽  
Clinical Criteria ◽  
Ct Head ◽  
A Minor

ABSTRACT AIM This study retrospectively reviewed the management of head injury at Lakes District Hospital in Queenstown, New Zealand. The aim is to describe the management of minor head injury with particular reference to the current Traumatic Brain Injury guidelines of the New Zealand Guidelines Group. METHODS We identified all patients with head injury as a primary diagnosis who were seen in the Emergency Department at Lakes District Hospital during 2013–2015. We recorded clinical criteria indicating need for computed tomography (CT) scanning according to current guidelines for management of minor head injury. RESULTS A total of 883 patients were seen with head injury as their primary diagnosis: 280 patients aged >15 years had a minor head injury that met current criteria for immediate CT scanning. Of these, 66 (23.6%) actually had a CT head scan. CONCLUSION The rate of CT head scanning for minor head injury in Queenstown does not comply with current New Zealand guidelines.

Moderate Head Injury: Completing the Clinical Spectrum of Brain Trauma

Neurosurgery ◽  
1982 ◽  
Vol 11 (3) ◽  
pp. 344-351 ◽  
Author(s):  
Rebecca W. Rimel ◽  
Bruno Giordani ◽  
Jeffrey T. Barth ◽  
John A. Jane
Keyword(s):  
Head Injury ◽  
Present Report ◽  
Economic Status ◽  
Head Injuries ◽  
Ct Scanning ◽  
Minor Head Injury ◽  
Good Recovery ◽  
Severe Injuries ◽  
Computed Tomographic ◽  
Severity Of Injury

Abstract We have divided head injury into three categories based on the Glasgow Coma Scale (GCS) (severe, 3–8; moderate, 9–12; and minor, 13–15). In a previous report, we described significant disability after minor head injury. The present report describes 199 patients with moderate head injury, 159 of whom underwent follow–up examinations at 3 months. In contrast to patients with minor head injury, half as many were students (17%) and twice as many were intoxicated (53%). Seventy–five patients were studied with computed tomographic (CT) scanning; 30% of the scans were negative and 31% showed a space–occupying mass. As reported by Gennarelli et al. in patients with severe head injuries, those with moderate head injury and subdural hematoma had a very poor outcome: 65% died or were severely disabled and none made a good recovery as measured by the Glasgow Outcome Scale. At 3 months, 38% of the moderate head injury patients had made a good recovery compared with 75% of the minor head injury patients. Within the good recovery category, however, there was much disability (headache, 93%; memory difficulties, 90% difficulties with activities of daily living, 87%), and only 7% of the patients were asymptomatic. The Halstead–Reitan Neuropsychological Battery in an unselected subset (n = 32) showed significant deficits on all test measures. Sixty–six per cent of the patients previously employed had not returned to work, compared to 33% of the minor head injury patients. The major predictors of unemployment after minor head injury were premorbid characteristics (age, education, and socio–economic status). In contrast, all predictors in moderate head injury were measures of the severity of injury (length of coma, CT diagnosis. GCS on discharge). We conclude that: (a) moderate head injury, not described previously in the literature, results in mortality and substantial morbidity intermediate between those of severe and minor head injury; (b) unlike minor head injury, the principal predictors of outcome after moderate head injury are measures of the severity of injury; and (c) more attention should be directed to patients with moderate head injury than to those with the most severe injuries, in whom brain damage is probably irreversible and all forms of management have demonstrated little success.

scholarly journals Clinical Predictors of Abnormal Computed Tomography Findings in Mild Head Injury

2018 ◽  
Vol 8 (2) ◽  
pp. 20-25
Author(s):  
Nikunj Yogi ◽  
Balgopal Karmacharya ◽  
Amrit Gurung
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Prospective Observational Study ◽  
Head Injuries ◽  
Minor Head Injury ◽  
Ct Scans ◽  
Clinical Predictors ◽  
Neurological Exam ◽  
Intracranial Lesions ◽  
A Minor

Introduction: Whether to scan a minor head injury with Glasgow Coma Scale (GCS) 15 who appears well and has a normal physical and neurological exam or not is an issue commonly faced in all emergency departments. In this study, we tried to assess the predictability of clinical parameters in predicting traumatic intracranial lesions in Computed Tomography (CT) scans of patients with minor head injuries with GCS 15.Methods: A prospective observational study was carried out in between January to December 2016 in Manipal Teaching Hospital, Pokhara, Nepal. Various clinical predictors of 415 cases of minor head injury with GCS 15 were assessed to see if they could predict the abnormal CT scans in these cases. Clinical variables found significant in bivariate analyses were further analyzed using logistic regression to calculate the odds of each variable to detect abnormal CT scans.Results: There were 119 (28.7%) abnormal CT scans in the study. Vomiting, LOC (Loss of Consciousness), seizure and headache were the significant predictors of abnormal CT scans with an odds of 4.254 (95% CI: 2.373-7.627), 2.396 (95% CI: 1.258-4.562), 5.803 (95% CI: 1.110-30.336) and 1.967 (95% CI: 1.008-3.839) respectivelyConclusion: Vomiting, LOC, seizure and headache are important clinical predictors of abnormal CT scan in cases of minor head injuries with GCS 15.

scholarly journals LO47: Incidence of intracranial bleeding in anticoagulated emergency patients with minor head injury: a meta-analysis

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S23-S23
Author(s):  
K. de Wit ◽  
H. Minas ◽  
W. Arthur ◽  
M. Turcotte ◽  
M. Eventov ◽  
...  
Keyword(s):  
Head Injury ◽  
Random Effects ◽  
Data Extraction ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Minor Head Injury ◽  
Significant Heterogeneity ◽  
Ct Head ◽  
A Minor

Introduction: The proportion of Canadians receiving anticoagulation medication is increasing. Falls in the elderly are the most common cause of minor head injury and an increasing proportion of these patients are prescribed anticoagulation. Emergency department (ED) guidelines advise performing a CT head scan for all anticoagulated head injured patients, but the risk of intracranial hemorrhage (ICH) after a minor head injury (patients who have a Glasgow comma score (GSC) of 15) is unclear. We conducted a systematic review and meta-analysis to determine the point incidence of ICH in anticoagulated ED patients presenting with a minor head injury. Methods: We systematically searched Pubmed, EMBASE, Cochrane database, DARE, google scholar and conference abstracts (May 2017). Experts were contacted. Meta-Analyses and Systematic Reviews of Observational Studies (MOOSE) guidelines were followed with two authors reviewing titles, four authors reviewing full text and four authors performing data extraction. We included all prospective studies recruiting consecutive anticoagulated ED patients presenting with a head injury. We obtained additional data from the authors of the included studies on the subset of GCS 15 patients. We performed a meta-analysis to estimate the point incidence of ICH among patients with a GCS score of 15 using a random effects model. Results: A total of five studies (and 4,080 GCS 15, anticoagulated patients) from the Netherlands, Italy, France, USA and UK were included in the analysis. One study contributed 2,871 patients. Direct oral anticoagulants were prescribed in only 60 (1.5%) patients. There was significant heterogeneity between studies with regards to mechanism of injury, CT scanning and follow up method (I2 =93%). The random effects pooled incidence of ICH was 8.9% (95% CI 5.0-13.8%). Conclusion: We found little data to reflect contemporary anticoagulant prescribing practice. Around 9% of warfarinized patients with a minor head injury develop ICH. Future studies should evaluate the safety of selective CT head scanning in this population.

BET 3: Observation is unnecessary following a normal CT brain in warfarinised head injuries: an update

2014 ◽  
Vol 31 (4) ◽  
pp. 339-342 ◽  
Keyword(s):  
Head Injury ◽  
Ct Scan ◽  
Patient Group ◽  
Intracranial Haemorrhage ◽  
Head Injuries ◽  
Minor Head Injury ◽  
Ct Brain ◽  
A Minor ◽  
Study Type

A short-cut review was carried out to determine whether patients on warfarin with a minor head injury can be discharged safely if they have a normal CT scan. 796 papers were found using the reported search, of which seven were considered relevant to the three-part question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses are shown in the accompanying table. It is concluded that the risk of delayed intracranial haemorrhage, at least in patients with an INR <3, is extremely small and discharge of these patients should be considered.

scholarly journals Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand

2020 ◽  
Vol 37 (11) ◽  
pp. 686-689
Author(s):  
Catherine L Wilson ◽  
Emma J Tavender ◽  
Natalie T Phillips ◽  
Stephen JC Hearps ◽  
Kelly Foster ◽  
...  
Keyword(s):  
New Zealand ◽  
Head Injury ◽  
North America ◽  
Emergency Departments ◽  
Head Injuries ◽  
Admission Rate ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Paediatric Head Injury ◽  
Tertiary Hospitals

ObjectivesCT of the brain (CTB) for paediatric head injury is used less frequently at tertiary paediatric emergency departments (EDs) in Australia and New Zealand than in North America. In preparation for release of a national head injury guideline and given the high variation in CTB use found in North America, we aimed to assess variation in CTB use for paediatric head injury across hospitals types.MethodsMulticentre retrospective review of presentations to tertiary, urban/suburban and regional/rural EDs in Australia and New Zealand in 2016. Children aged <16 years, with a primary ED diagnosis of head injury were included and data extracted from 100 eligible cases per site. Primary outcome was CTB use adjusted for severity (Glasgow Coma Scale) with 95% CIs; secondary outcomes included hospital length of stay and admission rate.ResultsThere were 3072 head injury presentations at 31 EDs: 9 tertiary (n=900), 11 urban/suburban (n=1072) and 11 regional/rural EDs (n=1100). The proportion of children with Glasgow Coma Score ≤13 was 1.3% in each type of hospital. Among all presentations, CTB was performed for 8.2% (95% CI 6.4 to 10.0) in tertiary hospitals, 6.6% (95% CI 5.1 to 8.1) in urban/suburban hospitals and 6.1% (95% CI 4.7 to 7.5) in regional/rural. Intragroup variation of CTB use ranged from 0% to 14%. The regional/rural hospitals admitted fewer patients (14.6%, 95% CI 12.6% to 16.9%, p<0.001) than tertiary and urban/suburban hospitals (28.1%, 95% CI 25.2% to 31.2%; 27.3%, 95% CI 24.7% to 30.1%).ConclusionsIn Australia and New Zealand, there was no difference in CTB use for paediatric patients with head injuries across tertiary, urban/suburban and regional/rural EDs with similar intragroup variation. This information can inform a binational head injury guideline.

scholarly journals The outcome of a pregnant woman with a minor head injury: an ossified subdural hematoma (OSDH)

2017 ◽  
Vol 2017 (3) ◽  
Author(s):  
Nese Keser ◽  
Erhan Celikoglu ◽  
İmam H. Aydın ◽  
Nurver Ozbay
Keyword(s):  
Pregnant Woman ◽  
Head Injury ◽  
Subdural Hematoma ◽  
Minor Head Injury ◽  
A Minor
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