A challenging decision for emergency physicians: Routine repeat computed brain tomography of the brain in head trauma in infants and neonates.

BACKGROUND: Head trauma is a leading cause of death and disability. While standard treatment protocols exist for severe head trauma, no clear follow-up standards are available for mild head trauma with positive imaging findings in infants and newborns. Although routine follow-up brain computed tomography (CT) imaging is not recommended for children with moderate and mild head trauma, the necessity for follow-up imaging in infants and newborns remains uncertain. METHODS: Our study is a retrospective, observational, and descriptive study. Infants under 1 year old presenting to the emergency department with isolated head trauma were reviewed with the approval of the Ethics Committee of Ankara Etlik City Hospital. Inclusion criteria included presentation to the emergency department, undergoing more than one brain CT scan, and sustaining mild head trauma (Glasgow Coma Scale [GCS] >13). Patients with incomplete follow-up data or multiple traumas were excluded. Age, gender, mechanism of trauma, initial and follow-up brain CT findings, hospital admission, and surgical procedures were recorded and analyzed using the SPSS statistical package. RESULTS: Out of 238 screened patients, 154 were included in the study. Of these, 66.9% were male and the average age was 5.99 months. The most common presenting symptom was swelling at the trauma site, observed in 79.2% of cases. The most common mechanism of injury was falling from a height of less than 90 cm, accounting for 85.1% of cases. Pathological progression on follow-up CT was observed in 5.2% of the patients, and only 1.9% required surgical treatment. A total of 34.4% of the patients required hospitalization. Patients with parenchymal brain pathology had a higher rate of pathological progression on follow-up CT and a longer hospital stay. CONCLUSION: Follow-up CT scans in infants with mild head trauma do not alter patient outcomes except in cases with brain parenchymal pathology. Study data indicated that repeat imaging is not beneficial for isolated skull fractures. Imaging artifacts often necessitated repeated scans, contributing to increased radiation exposure. Unnecessary repeat imaging escalates radiation exposure and healthcare costs. Only a small percentage of patients exhibited progression of intracranial pathology, justifying follow-up imaging solely in the presence of brain parenchymal injury. Larger prospective studies are necessary to confirm these findings.

The Prognostic Accuracy of Get With The Guidelines-Heart Failure Score Alone and with Lactate Among Acute Symptomatic Heart Failure Patients: A Retrospective Cohort Study.

BACKGROUND: To evaluate the prognostic accuracy of the Get With The Guidelines-Heart Failure (GWTG-HF) score, Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (Age-SI) alone and with lactate in patients with acute symptomatic heart failure (HF). METHODS: A retrospective cohort study was conducted in the emergency department of a tertiary hospital between January 1, 2019, and December 31, 2019. Patients aged >18 years and diagnosed with acute symptomatic HF were consecutively included in the study. Patients referred from another center and missing medical records were excluded. Arrival type, vital parameters, demographic characteristics, comorbid diseases, consciousness status, laboratory results, and outcomes of the patients were recorded. The primary endpoint of the study was in-hospital mortality. RESULTS: A total of 368 patients were included in the final analysis. The in-hospital mortality rate of the patients was 7.6%. The GWTG-HF score outperformed other scores in predicting in-hospital, 24-hour, and 30-day mortality (area under the curve (AUC) = 0.807, 0.844, and 0.765, P <.001, respectively). The overall performance of the GWTG-HF score with lactate (GWTG-HF+L) was better in predicting in-hospital, 24-hour, and 30-day mortality than the original GWTG-HF score (AUC = 0.872, 0.936, and 0.801, P <.001, respectively). Adding lactate values to the SI, MSI, and Age-SI improved their overall performance for all 3 outcomes. CONCLUSION: Both the GWTG-HF and GWTG-HF+L scores have acceptable discriminatory power in patients with acute symptomatic HF. The GWTG-HF score, SI, MSI, and Age-SI can be used together with lactate to predict mortality in patients with acute HF.

Effectiveness of Mesenchymal Stem Cell Therapy for COVID-19 Patients in the Intensive Care Unit: A Case-Control Study

Objective: Many methods are used in the treatment of coronavirus disease 2019 (COVID-19), which causes acute respiratory distress syndrome (ARDS), and there are conflicting reports in the literature regarding the results of mesenchymal stem cell (MSC) therapy, which is one of those methods. The aim of our study is to evaluate the effect of MSC treatment applied together with standard treatments on survival. Materials and Methods: This retrospective case-control study evaluates the survival effect of MSC treatment administered to patients treated in intensive care after the development of ARDS due to COVID-19 between March 2020 and March 2021. The age, gender, comorbid disease status, APACHE II score, and overall and comorbidity-based survival rates were compared between patients who received standard medical treatment (SMT) and patients who received MSC treatment together with SMT. Results: There were 62 patients in the group receiving only SMT and 81 patients in the group receiving SMT and MSC. No difference was observed between the groups in terms of age, gender, presence of comorbid diseases, or APACHE II scores. There were also no differences according to Kaplan-Maier analysis for the survival statuses of the groups. There was no serious adverse effect due to MSC treatment among these patients. Conclusion: Our study presents the largest case series in the literature, and it was observed that MSC treatment may not significantly affect overall survival or comorbid disease-based survival, in contrast to many other studies in the literature.