Morning quickie

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We scan everyone with LOC. Lesions requiring intervention are found, but
probably(much?) less than 1%. Part of the rationale is that those with
negative scans can be discharged and not observed.

Rob Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Bjorn, Pret
Sent: Tuesday, October 02, 2007 7:54 AM
To: Trauma & Critical Care mailing list
Subject: RE: Morning quickie

Long time, no quickies. 

>From PubMed ("trauma AND seizure AND brain injury"):
Manassiez et al. "Indications for brain scan in patients with benign
cranial injury"  J Radiol. 2007 Apr;88(4):567-71 -- 285 patients, GCS
15, neurologically WNL but transient loss of consciousness.  "Patients
with a positive CT all had at least one clinical risk factor [HA,
vomiting, convulsion, etc.] and patients with cranioencephalic lesions
had at least two risk factors present."  No comment on whether
craniocephalic lesions were surgical.
I followed the "related articles" link from this and found several
similar studies with similar results.  Nothing especially conclusive,
but it appears the risks of significant missed injury are rather
microscopic.  
In practical terms, you're not going to get a neurosurgeon to operate
without a worsening neurologic picture anyhow, and even in the context
of sudden onset coma he'll want another CT first; so why not just
observe, thereby saving at least one scan?

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ross Hofmeyr
Sent: Tuesday, October 02, 2007 2:21 AM
To: trauma-list at trauma.org
Subject: Morning quickie

Hi all,

Quick question - in patients with an isolated head injury who do not
have other indication for CT (low GCS/worsening LOC/focal signs) but
have a seizure, what is the incidence of radiologically detectable
injury?  Specifically, what percentage need subsequent neurosurgical
intervention?

Your input anticipated,
Ross.

-- 
_____________________
Ross Hofmeyr
MBChB (Stell) ATLS ACLS
wildmedic at gmail.com
ross at wildmedix.com
www.wildmedix.com
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