Objective A retrospective audit of minor traumatic brain injury presentations to three Brisbane emergency departments aiming to assess rates of CT scans and compliance with the Canadian CT Head Rule (CCTHR), as well as reviewing the demographics of patients and their management. Method Minor traumatic brain injury presentations to the Emergency departments of the Royal Brisbane and Women’s Hospital, Redcliffe Hospital and Queen Elizabeth II Hospital between July 1st and August 30th, 2019 were identified via diagnosis searches in patient tracking systems. Data collected included patient demographics, use of CT scans and Abbreviated Westmead Post Traumatic Amnesia Scale assessment, length of stay and discharge advice regarding return to sport. Results 200 minor traumatic brain injury presentations were included. 75% of patients received a CT head with only 9% of these found to be non-compliant with the CCTHR. The most common indications for CTs were age >65, GCS <15 at 2 hours post injury and anticoagulation. Only 40% of patients that qualified for A-WTPAS received the assessment. 18% of presentations were due to sporting injuries and 69% were not given return to play advice. The average length of stay was 250 minutes with 41.5% of presentations longer than 4 hours. 99% of the patients were discharged home from the ED with 1% admitted. Conclusion The study characterised minor traumatic brain injury management across three emergency departments and showed that most patients received CT head scans that were indicated. However, other areas of management such as A-WPTAs and return to play advice must be improved.

Background Serotonin toxicity is a known side effect of selective serotonin reuptake inhibitors and has previously also been described as a possible side effect of 5-hydroxytryptamine receptor agonist (triptan) medications. However, the literature is conflicted about the risk of developing serotonin toxicity as a result of drug interaction between selective serotonin reuptake inhibitors and triptans. Case presentation A 30-year-old Caucasian woman with a history of depression on regular fluvoxamine presented to the emergency department with right-sided facial and lower limb twitching. The patient had recently been prescribed sumatriptan for migraines and had taken her first ever dose shortly prior to the onset of symptoms. She was tachycardic, diaphoretic, and hypertonic on initial assessment with bilateral lower limb and ocular clonus. Electrocardiogram showed sinus tachycardia with QT interval under the treatment interval, and pathology and imaging findings were unremarkable. Her symptoms improved with supportive management and cyproheptadine. Conclusions This patient’s presentation fulfilled both Sternbach and Hunter criteria for serotonin toxicity, illustrating a potential case of serotonin toxicity as a result of drug interaction between a selective serotonin reuptake inhibitor and a triptan.