No abstract

No abstract

ABSTRACTEffective preparedness, response, and recovery from disasters require a well-planned, integrated effort with experienced professionals who can apply specialized knowledge and skills in critical situations. While some professionals are trained for this, others may lack the critical knowledge and experience needed to effectively perform under stressful disaster conditions. A set of clear, concise, and precise training standards that may be used to ensure workforce competency in such situations has been developed. The competency set has been defined by a broad and diverse set of leaders in the field and like-minded professionals through a series of Web-based surveys and expert working group meetings. The results may provide a useful starting point for delineating expected competency levels of health professionals in disaster medicine and public health.(Disaster Med Public Health Preparedness. 2012;6:44–52)

No abstract

No abstract

WHAT'S KNOWN ON THIS SUBJECT:Emergency-department observation of children with minor blunt head trauma for symptom progression before making a decision regarding computed tomography may decrease computed tomography use. The actual impact of this strategy on computed tomography use and clinical outcomes, however, is unknown. WHAT THIS STUDY ADDS:Clinicians currently observe some children with head trauma before deciding whether to obtain a cranial computed tomography scan. Patients who were observed had a significantly lower rate of overall cranial computed tomography use after adjusting for markers of head injury severity.abstract OBJECTIVE: Children with minor blunt head trauma often are observed in the emergency department before a decision is made regarding computed tomography use. We studied the impact of this clinical strategy on computed tomography use and outcomes. METHODS:We performed a subanalysis of a prospective multicenter observational study of children with minor blunt head trauma. Clinicians completed case report forms indicating whether the child was observed before making a decision regarding computed tomography. We defined clinically important traumatic brain injury as an intracranial injury resulting in death, neurosurgical intervention, intubation for longer than 24 hours, or hospital admission for 2 nights or longer. To compare computed tomography rates between children observed and those not observed before a decision was made regarding computed tomography use, we used a generalized estimating equation model to control for hospital clustering and patient characteristics. RESULTS: Of 42 412 children enrolled in the study, clinicians noted if the patient was observed before making a decision on computed tomography in 40 113 (95%). Of these, 5433 (14%) children were observed. The computed tomography use rate was lower in those observed than in those not observed (31.1% vs 35.0%; difference: Ϫ3.9% [95% confidence interval: Ϫ5.3 to Ϫ2.6]), but the rate of clinically important traumatic brain injury was similar (0.75% vs 0.87%; difference: Ϫ0.1% [95% confidence interval: Ϫ0.4 to 0.1]). After adjustment for hospital and patient characteristics, the difference in the computed tomography use rate remained significant (adjusted odds ratio for obtaining a computed tomography in the observed group: 0.53 [95% confidence interval: 0.43-0.66] Minor blunt head trauma is a common reason for children to present to the emergency department, 1 although the prevalence of traumatic brain injury (TBI) is low. [2][3][4][5] Cranial computed tomography (CT) is the reference standard for emergently diagnosing TBI in children. Clinicians frequently include an emergent CT in the diagnostic evaluation of children with nontrivial blunt head trauma who present to the emergency department. Furthermore, emergency-department utilization of cranial CT has increased substantially over the last decade. 6,7 Cranial CT is not without risks. Most important are the long-term risks of lethal malignancy induced from the ionizing rad...

Managing pediatric head trauma with elevated intracranial pressure in the acute setting can be challenging. Bedside ocular ultrasound for measuring optic nerve sheath diameters has been recently proposed as a portable noninvasive method to rapidly detect increased intracranial pressure in emergency department patients with head trauma. Prior study data agree that the upper limit of normal optic nerve sheath diameters is 5.0 mm in adults, 4.5 mm in children aged 1 to 15, and 4.0 mm in infants up to 1 year of age. We report the application of this technique to 3 cases of head trauma in the pediatric emergency department.

Prognostic/epidemiologic study, level III; therapeutic study, level IV.