Management of head-injured patients in the emergency department: A practical protocol

Arienta, Cesare; Caroli, Manuela; Balbi, Sergio

doi:10.1016/s0090-3019(97)00019-0

Cited by 55 publications

(54 citation statements)

References 20 publications

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“…The design and patient characteristics of the 19 studies (representing 22 articles) 26,27,29,46,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] that evaluated the diagnostic performance of clinical decision rules for identifying ICI or need for neurosurgery in adults with MHI are summarised in Table 2. Eight studies were from the USA, 27,29,55,58,59,61,62,64 two each from Italy, 54,57,71 Canada 26,46 and the Islamic Republic of Iran, 66,67 and one each from the Netherlands, [68][69][70] Australia, 65 Japan, 63 Spain 60 and Denmark.…”

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

“…Eight studies were from the USA, 27,29,55,58,59,61,62,64 two each from Italy, 54,57,71 Canada 26,46 and the Islamic Republic of Iran, 66,67 and one each from the Netherlands, [68][69][70] Australia, 65 Japan, 63 Spain 60 and Denmark. 56 Six were multicentre studies.…”

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

“…62 Fourteen studies derived a new rule. 26,27,29,[54][55][56]60,[61][62][63][64]66,67,69 Four studies 46,57,60,[68][69][70][71] reported validation results for more than one rule in the same cohort. Data were collected prospectively in 15 studies, 26,27,29,46,[56][57][58][59][60][61][62][63][66][67][68][69][70][71] of which participants were recruited consecutively in 13, 26,27,29,[56][57][58][59][60]62,63,…”

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

“…61 The remaining four studies were retrospective. 54,55,64,65 Of the 19 studies, three reported both a derivation and a validation cohort, 27,61,63 making a total of 22 different cohorts.…”

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

“…29,56,59,61,62 In seven studies, 29,55,59,61,62,64,65 patients were enrolled only if they had a CT scan and in nine studies 26,27,29,46,55,58,59,65,[68][69][70] patients were selected on the basis of clinical characteristics, such as amnesia or LOC at presentation, which, in some studies, were used as criteria for having a CT scan. Five studies defined MHI as GCS 14-15 54,57,58,60,63,71 and included only patients presenting within this range. Four studies collected data only on those with GCS 15,27,29,65,67 one study collected data on GCS 14 only, 59 two studies 61,62 included data from all GCS categories and two did not report GCS status.…”

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

See 4 more Smart Citations

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Pandor

Goodacre²,

Harnan³

et al. 2011

Health Technol Assess

110

114

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTADiagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA...

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Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

“…61 The remaining four studies were retrospective. 54,55,64,65 Of the 19 studies, three reported both a derivation and a validation cohort, 27,61,63 making a total of 22 different cohorts.…”

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

Section: Clinical Decision Rules Description Of Included Studies Adultsmentioning

confidence: 99%

See 3 more Smart Citations

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Pandor

Goodacre²,

Harnan³

et al. 2011

Health Technol Assess

110

114

View full text Add to dashboard Cite

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Mild Traumatic Brain Injury

Vos

Alekseenko

Battistin

et al. 2006

European Handbook of Neurological Management

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Traumatic brain injury (TBI) is one among the most frequent neurological disorders. Of all TBIs 90% are considered mild with an annual incidence of 100-300/100 000. Intracranial complications of mild traumatic brain injury (MTBI) are infrequent (10%), requiring neurosurgical intervention in a minority of cases (1%), but poten tially life threatening (case fatality rate 0.1%). Hence, a true health management problem exists because of the need to exclude the small chance of a life-threatening complication in a large number of individual patients. The 2002 EFNS guideline used the best evidence approach based on the literature until 2001 to guide initial man agement with respect to indications for computed tomography (CT), hospital admis sion, observation and follow-up of MTBI patients. This updated EFNS guideline for initial management in MTBI proposes a more selective strategy for CT when major [dangerous mechanism, Glasgow Coma Scale (GCS) < 15, 2 points deterioration on the GCS, clinical signs of (basal) skull fracture, vomiting, anticoagulation therapy, post-traumatic seizure] or minor (age, loss of consciousness, persistent anterograde amnesia, focal deficit, skull contusion, deterioration on the GCS) risk factors are present based on published decision rules with a high level of evidence. In addition, clinical decision rules for CT now exist for children as well. Since 2001, recommen dations, although with a lower level of evidence, have been published for clinical observation in hospitals to prevent and treat other potential threats to the patient including behavioural disturbances (amnesia, confusion and agitation) and infection.

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Minor and Repetitive Head Injury

Büki¹,

Kovács

Czeiter

et al. 2014

Advances and Technical Standards in Neurosurgery

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Traumatic brain injury (TBI) is the leading cause of death and disability in the young, active population and expected to be the third leading cause of death in the whole world until 2020. The disease is frequently referred to as the silent epidemic, and many authors highlight the "unmet medical need" associated with TBI.The term traumatically evoked brain injury covers a heterogeneous group ranging from mild/minor/minimal to severe/non-salvageable damages. Severe TBI has long been recognized to be a major socioeconomical health-care issue as saving young lives and sometimes entirely restituting health with a timely intervention can indeed be extremely cost efficient.Recently it has been recognized that mild or minor TBI should be considered similarly important because of the magnitude of the patient population affected. Other reasons behind this recognition are the association of mild head injury with transient cognitive disturbances as well as long-term sequelae primarily linked to repeat (sport-related) injuries.The incidence of TBI in developed countries can be as high as 2-300/100,000 inhabitants; however, if we consider the injury pyramid, it turns out that severe and moderate TBI represents only 25-30 % of all cases, while the overwhelming majority of TBI cases consists of mild head injury. On top of that, or at the base of the pyramid, are the cases that never show up at the ER - the unreported injuries.Special attention is turned to mild TBI as in recent military conflicts it is recognized as "signature injury."This chapter aims to summarize the most important features of mild and repetitive traumatic brain injury providing definitions, stratifications, and triage options while also focusing on contemporary knowledge gathered by imaging and biomarker research.Mild traumatic brain injury is an enigmatic lesion; the classification, significance, and its consequences are all far less defined and explored than in more severe forms of brain injury.Understanding the pathobiology and pathomechanisms may aid a more targeted approach in triage as well as selection of cases with possible late complications while also identifying the target patient population where preventive measures and therapeutic tools should be applied in an attempt to avoid secondary brain injury and late complications.

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Management of head-injured patients in the emergency department: A practical protocol

Cited by 55 publications

References 20 publications

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

Mild Traumatic Brain Injury

Minor and Repetitive Head Injury

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