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1.
Radiol Med ; 125(6): 595-599, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32048156

RESUMO

In recent years, the increasing prescription of diagnostic imaging has been noted, due to advances in imaging technology and the development of defensive medicine. Overuse of diagnostic imaging significantly impacts the quality and costs of health care. Therefore, the purpose of this study was to quantify overprescription and investigate its causes through the evaluation of head computer tomography (CT) scan prescriptions. In this study, a set of 100 requests of CT scans was collected and analysed by three experts in guidelines and scientific evidences, evaluating prescription appropriateness. Then, the rate of overprescription was quantified and its causes identified as incorrect adoption of guidelines indications (32%) and as defensive medicine (6%). Therefore, in order to reduce inappropriate investigations, the findings of the present study suggest that the reduction in overprescription could be reached through the improvement of training of health personnel and the propagation of a no-blame culture aimed at minimizing defensive medicine.


Assuntos
Traumatismos Craniocerebrais/diagnóstico por imagem , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Adulto Jovem
2.
Ann Emerg Med ; 75(2): 192-205, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31256906

RESUMO

STUDY OBJECTIVE: Large-scale quality and performance measurement across unaffiliated hospitals is an important strategy to drive practice change. The Michigan Emergency Department Improvement Collaborative (MEDIC), established in 2015, has baseline performance data to identify practice variation across 15 diverse emergency departments (EDs) on key emergency care quality indicators. METHODS: MEDIC is a unique physician-led partnership supported by a major third-party payer. Member sites contribute electronic health record data and trained abstractors add supplementary data for eligible cases. Quality measures include computed tomography (CT) appropriateness for minor head injury, using the Canadian CT Head Rule for adults and Pediatric Emergency Care Applied Network rules for children; chest radiograph use for children with asthma, bronchiolitis, and croup; and diagnostic yield of CTs for suspected pulmonary embolism. Baseline performance was established with statistical process control charts. RESULTS: From June 1, 2016, to October 31, 2017, the MEDIC registry contained 1,124,227 ED visits, 23.2% for children (<18 years). Overall baseline performance included the following: 40.9% of adult patients with minor head injury (N=11,857) had appropriate CTs (site range 24.3% to 58.6%), 10.3% of pediatric minor head injury cases (N=11,183) exhibited CT overuse (range 5.8% to 16.8%), 38.1% of pediatric patients with a respiratory condition (N=18,190) received a chest radiograph (range 9.0% to 62.1%), and 8.7% of pulmonary embolism CT results (N=16,205) were positive (range 7.5% to 14.3%). CONCLUSION: Performance varied greatly, with demonstrated opportunity for improvement. MEDIC provides a robust platform for emergency physician engagement across ED practice settings to improve care and is a model for other states.


Assuntos
Traumatismos Craniocerebrais/diagnóstico por imagem , Serviço Hospitalar de Emergência/normas , Sobremedicalização/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Radiografia Torácica/normas , Tomografia Computadorizada por Raios X/normas , Adolescente , Adulto , Criança , Pré-Escolar , Medicina de Emergência/normas , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Michigan , Guias de Prática Clínica como Assunto , Embolia Pulmonar/diagnóstico por imagem , Radiografia Torácica/estatística & dados numéricos , Sistema de Registros , Doenças Respiratórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos
3.
Ulus Travma Acil Cerrahi Derg ; 25(6): 622-627, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31701501

RESUMO

BACKGROUND: In our study, we have tried to find out how necessary whole-body computed tomography (WBCT) is to detect other body injuries that may accompany the patients, evaluating head trauma cases with WBCT. METHODS: In our study, we included 198 patients, who were referred to our hospital's emergency service after head trauma, had brain lesions detected in brain tomography (BT), had no additional examination findings and who underwent WBCT. In this retrospective study, patients' age, gender, type of lesion in brain CT, Glasgow Coma Scale (GCS) values and WBCT findings were examined. RESULTS: In this study, 85.4% of the patients were male and the average age was 25.7 years. The most common cranial CT findings were fracture, followed by parenchymal bleeding. 67% of the patients' GCS were below 8. Additional trauma was detected in 78 of the patients (39.4%). The most common additional lesion was the thoracic contusion. The mean age of the patients with cervical injuries determined in CT was significantly high (p<0.05). Statistical significance was determined between cranial fracture, foreign body incidence and thoracic injuries (p<0.05). The incidence of cervical injuries was significantly higher in patients with brain contusion detected in CT (p<0.05). Fracture frequency and presence of additional lesions in WBCT were significantly high (p<0.05). There was no correlation between other cranial lesions and additional injury areas (p>0.05). CONCLUSION: The number of studies evaluating WBCT is high in the literature. However, our study is important concerning that to our knowledge this study is the first study to evaluate the WBCT findings in the head trauma cases without the additional lesions on their bodies. WBCT scan should be recommended in patients whose clinical evaluation could not be completed. WBCT is an important diagnostic tool for the diagnosis of many pathologies, especially for intrathoracic lesions.


Assuntos
Traumatismos Craniocerebrais , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Imagem Corporal Total/estatística & dados numéricos , Adulto , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/epidemiologia , Guias de Prática Clínica como Assunto , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/epidemiologia
4.
Otolaryngol Pol ; 73(5): 5-11, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31701901

RESUMO

INTRODUCTION: Computed tomography is an important imaging technique in Emergency Units. Thanks to its popularity, radiological changes are found in healthy children more commonly. The aim of this paper is to evaluate the incidence of maxillary sinus radiological changes in children with head trauma who admitted to the Emergency Unit of the University Children Hospital in Lublin. MATERIAL AND METHODS: A retrospective analysis of computed tomography scans of children suffering from head trauma admitted to the Emergency Unit of the University Children Hospital in Lublin was carried out. A group of 425 patients was analyzed. RESULTS: Maxillary findings were present in 81 cases (19.06%); in 38 patients (8.94%) the changes were unilateral, while in 43 (10.12%) they were bilateral. Maxillary mucosal thickening was the most common radiological abnormality, present in almost 12% of the investigated cases (approximately 62% of all revealed changes). Maxillary total opacification as an isolated finding was found in younger children only. Retention cysts and maxillary polyps were found with a similar low frequency as maxillary opacification but in elder children only. DISCUSSION: Asymptomatic radiological changes in computed tomography scans are common. Maxillary mucosal thickening is the most frequent asymptomatic abnormality. Maxillary polyps and pseudocysts are rare in the paediatric population. Maxillary opacification suggests other more significant pathologies and requires further diagnostics. Physicians should avoid diagnosing patients with sinusitis without proper examination and based on radiological abnormalities only. Paediatric patients with revealed maxillary changes should remain under regular laryngological control.


Assuntos
Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/patologia , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/patologia , Adolescente , Criança , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Estudos Retrospectivos , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
5.
Clin J Sport Med ; 29(6): 442-450, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688173

RESUMO

OBJECTIVE: Youth athletes are believed to be more susceptible to white matter (WM) degradation resulting from head impact exposure relative to high school (HS) athletes; this hypothesis has not been objectively tested. The purpose of this study was to determine preseason to postseason changes in WM integrity from repetitive head impacts for youth football (YFB) players compared with HS football players during a competitive football season. DESIGN: Prospective cohort. SETTING: One season of YFB (grades 7 and 8) and varsity HS football (grades 10-12). PATIENTS OR OTHER PARTICIPANTS: Twelve YFB (13.08 ± 0.64 years) and 21 HS (17.5 ± 0.78 years) athletes. INTERVENTIONS: Participants completed 2 magnetic resonance imaging sessions: preseason and postseason. Head impact exposure was recorded during practice and games using a helmet-mounted accelerometer. MAIN OUTCOME MEASURES: Tract-based spatial statistics were used to evaluate group differences in preseason to postseason changes in diffusion tensor imaging, including fractional anisotropy and mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). RESULTS: The HS group exhibited significant preseason to postseason reductions in MD, AD, and RD (P < 0.05, corrected) in widespread WM areas. Significant WM reductions for the YFB group were only observed for AD (P < 0.05, corrected), but was more limited in extent compared with HS. CONCLUSIONS: Significant preseason to postseason AD reduction was found in both YFB and HS groups after one season of competitive play. Our results did not confirm recent speculation that younger children are more susceptible to the deleterious effects of repetitive head impacts compared with their older counterparts.


Assuntos
Comportamento Competitivo/fisiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/patologia , Futebol Americano/lesões , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Adolescente , Fatores Etários , Criança , Imagem de Tensor de Difusão , Humanos , Projetos Piloto , Estudos Prospectivos , Fatores de Tempo
6.
Acta Chir Orthop Traumatol Cech ; 86(5): 342-347, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748109

RESUMO

PURPOSE OF THE STUDY The aim of our study is to show the pitfalls of performing skull X-rays in patients with head injuries and the lack of accuracy of this examination nowadays, and to clarify the current trend in the MTBI investigation algorithm. MATERIAL AND METHODS A retrospective study of 3,950 patients treated for acute head injury at the Department of Trauma Surgery (University Hospital Brno) in the period from 2015 to 2016. Inclusion criteria were the following: mild brain injury (GCS = 15), primary skull X-ray design in head injury diagnosis. Patients with a positive skull X-ray finding underwent a head CT evaluation up to 24-hours from the injury except for the patients with an isolated nose bone fracture. A CT head scan was also performed in patients indicated by the neurologist at the initial examination based on the anamnestic data and an objective finding. RESULTS Inclusion criteria were met by 1,938 patients. In 1806 (93.2%) cases the X-ray was negative, in 132 (6.8%) patients the X-ray was positive, of which in 62% of patients a nasal fracture was detected. A skull fracture reported in 16 cases. Once the CT scan of the head was obtained, all of these cases were classified as false negative. After the CT scan of the head, intracranial bleeding was observed in 12 patients, in 4 cases accompanied by fractures of the skull, not visible on the X-ray images. After the statistical evaluation, the sensitivity and specificity of the X-ray examination compared to the CT scan of the head was determined to be 0.00 and 0.94, respectively. DISCUSSION The aim of MTBI diagnostics is primarily to detect serious intracranial lesions requiring neurosurgical intervention. A simple X-ray of the skull shows fractures only and does not allow to visualize both the brain and any traces of bleeding that would show an intracranial injury. Hofman, in his meta-analysis, points out that a simple X-ray image of the skull has only very little noticeable value when diagnosing MTBI. The prevalence of intracerebral hematoma (ICH) over MTBI is 0.083. The sensitivity of a radiographic finding of skull fracture in the diagnosis of ICH based on the CT verification is only 0.38 with a specificity of 0.95, which is consistent with our study where the sensitivity of the radiographic finding was 0.00 with a specificity of 0.94 relative to CT. Thus, the question is not whether to perform an X-ray of the skull in mild head injuries, but rather when to indicate a CT scan of the brain, when to admit the patient to the hospital for observation, and for how long or when the patient can be safely discharged into home care. The purpose of MTBI diagnostics, however, should not be a rashly decision to perform a brain CT scan, but to put into practice the CT indication criteria in MTBI applying and respecting the validated guidelines known worldwide. CONCLUSIONS Our study, in which no X-ray examination revealed possible intracranial bleeding, clearly shows that nowadays the plain radiograph of the skull does not bring any benefit in the diagnosis of minor traumatic brain injury. Key words:skull X-ray, CT of the head, head injury, minor traumatic brain injury.


Assuntos
Encéfalo/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem , Crânio/diagnóstico por imagem , Algoritmos , Lesões Encefálicas/diagnóstico por imagem , Traumatismos Craniocerebrais/complicações , Humanos , Estudos Retrospectivos , Fraturas Cranianas/etiologia , Tomografia Computadorizada por Raios X , Raios X
7.
Chin J Traumatol ; 22(5): 286-289, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31521457

RESUMO

PURPOSE: A head injury (HI) may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture (SBF) is a linear fracture at the base of the skull. Loss of consciousness and Glasgow coma score (GCS) may vary depending on an associated intracranial pathology. The pathomechanism is believed to be caused by high energy impact directly to the mastoid and supraorbital bone or indirectly from the cranial vault. Aim of this study is to define the correlation between SBF and intracranial hemorrhage (ICH) in patients with HI. METHODS: Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to diagnostic criteria of SBF patients based only on clinical symptoms associated with ICH caused by HI treated in the Department of Neurosurgery at Dr. Hasan Sadikin Hospital, Bandung, Indonesia from January 1, 2012 to December 31, 2017. The exclusion criteria included age less than 15 years and no head computed tomography (CT) scan examination provided. RESULTS: A total of 9006 patients were included into this study in which they were divided into 3 groups: group 1, HI with no ICH; group 2, HI with single ICH and group 3, HI with multiple ICH. In all the SBF cases, SBF at anterior fossa accounted for 69.40% of them, which were mostly accompanied with mild HI (64.70%). Severity of HI and site of SBF correlated with the existence of traumatic brain lesions on CT scan, thus these factors were able to predict whether there were traumatic brain lesions or not. Most of the patients with epidural hemorrhage (EDH) has single traumatic lesion on CT scan, whereas most of the patients with cerebral contusion (CC) has multiple traumatic lesions on CT scan. On patients with both traumatic brain injury and SBF, most of the patients with anterior fossa SBF has EDH; whereas most of the patients with middle fossa SBF were accompanied with CC. Surgery was not required for most of the patients with SBF. CONCLUSION: SBFs were strongly correlated with traumatic ICH lesions patients with anterior fossa SBF were more likely to suffer EDH whereas with middle fossa SBF were more likely to suffer CC.


Assuntos
Lesões Encefálicas Traumáticas/etiologia , Traumatismos Craniocerebrais/complicações , Hemorragias Intracranianas/etiologia , Base do Crânio/lesões , Fraturas Cranianas/etiologia , Adulto , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Feminino , Humanos , Incidência , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/epidemiologia , Masculino , Estudos Retrospectivos , Base do Crânio/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem
8.
Radiographics ; 39(4): 1161-1182, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283455

RESUMO

Routine non-contrast material-enhanced head CT is one of the most frequently ordered studies in the emergency department. Skull base-related pathologic entities, often depicted on the first or last images of a routine head CT study, can be easily overlooked in the emergency setting if not incorporated in the interpreting radiologist's search pattern, as the findings can be incompletely imaged. Delayed diagnosis, misdiagnosis, or lack of recognition of skull base pathologic entities can negatively impact patient care. This article reviews and illustrates the essential skull base anatomy and common blind spots that are important to radiologists who interpret nonenhanced head CT images in the acute setting. The imaging characteristics of important "do not miss" lesions are emphasized and categorized by their cause and location within the skull base, and the potential differential diagnoses are discussed. An interpretation checklist to improve diagnostic accuracy is provided. ©RSNA, 2019.


Assuntos
Traumatismos Craniocerebrais/diagnóstico por imagem , Base do Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Lista de Checagem , Transtornos da Consciência/diagnóstico por imagem , Doenças dos Nervos Cranianos/diagnóstico por imagem , Emergências , Dor Facial/diagnóstico por imagem , Cefaleia/diagnóstico por imagem , Humanos , Hipertensão Intracraniana/diagnóstico por imagem , Órbita/diagnóstico por imagem , Convulsões/diagnóstico por imagem , Base do Crânio/anatomia & histologia , Base do Crânio/lesões , Osso Temporal/diagnóstico por imagem , Traumatismos do Sistema Nervoso/diagnóstico por imagem , Transtornos da Visão/diagnóstico por imagem
9.
Ulus Travma Acil Cerrahi Derg ; 25(4): 378-382, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297787

RESUMO

BACKGROUND: Head trauma is a health problem that may be observed in all age groups, and it may cause significant losses in terms of health and economy. The purpose of our study is to evaluate the abnormal computerized brain tomography (CBT) prevalence and the rate of admission to brain surgery clinics in patients who applied to the Emergency Service Department for CBT due to minor head trauma. METHODS: In the present study, the patients who were admitted to Afyonkarahisar Health Sciences University, Faculty of Medicine Hospital, Emergency Service Department between January 1st, 2017, and December 31st, 2017, due to head trauma and in who CBT was performed were examined retrospectively. The electronic files, CBTs, and consultation notes of these patients were accessed in the information system of the hospital. RESULTS: A total of 43,389 patients who applied to the Emergency Service Department in 1 years' time (2017) were examined retrospectively. As a result of the examination, it was determined that a total of 2,515 (5.7%) patients received CBT. The reason for a total of 1,152 (45%) of these patients was traumatic injury. It was determined that 618 (53.6%) of the patients in who CBT was performed due to trauma were aged <18 years; 280 (24.3%) patients were aged <2 years; 179 (15.5%) patients had to consult with the Brain Surgery Clinic; and 94 (8.1%) were hospitalized. It was also determined that there were abnormal computed tomography (CT) findings in only 68 (5.9%) of the patients in who CBT was performed. CONCLUSION: The use of CBT indication criteria, which have been previously established and which reliability has been proven, in emergency trauma cases applying to the Emergency Service Department with minor head traumas may reduce the complication risk that may appear as a result of an unnecessary CBT and avoid complications that may occur in the long run due to CBT.


Assuntos
Encéfalo/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Escala de Coma de Glasgow , Hospitalização , Humanos , Lactente , Hemorragia Intracraniana Traumática/diagnóstico por imagem , Hemorragia Intracraniana Traumática/epidemiologia , Masculino , Pessoa de Meia-Idade , Neuroimagem , Prevalência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/epidemiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Eur J Paediatr Neurol ; 23(4): 604-608, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31147107

RESUMO

Pediatric abusive head trauma (AHT) or non accidental head trauma (NAHT) is a major cause of death from trauma in children under 2 years of age. Main etiological factor for non accidental head trauma is shaking a baby, causing brain injury by rotational head acceleration and deceleration. The consequent brain damage as shown by magnetic resonance imaging (MRI) is subdural haemorrhage and to a lesser extent parenchymal injuries of variable severity. Involvement of the cerebellum has very rarely been described. We report the clinical history and the development of cerebral magnetic resonance imaging findings in two children with serious brain injury following probable shaking who presented the typical "triad" with subdural haematoma, retinal haemorrhage and encephalopathy. We want to draw attention to cerebellar involvement characterized by cortico-subcortical signal alterations most prominent on T2w images following diffusion changes during the acute period. We discuss cerebellar involvement as a sign of higher severity of AHT which is probably underrecognized.


Assuntos
Lesões Encefálicas/patologia , Cerebelo/lesões , Cerebelo/patologia , Maus-Tratos Infantis , Traumatismos Craniocerebrais/patologia , Lesões Encefálicas/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Maus-Tratos Infantis/diagnóstico , Traumatismos Craniocerebrais/diagnóstico por imagem , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética/métodos , Masculino
11.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(5): 603-606, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31198148

RESUMO

OBJECTIVE: To investigate the dynamic changes in early gastric antrum contraction in patients with craniocerebral injury. METHODS: The patients with craniocerebral injury admitted to neurosurgery intensive care unit (ICU) of the First Affiliated Hospital of Sun Yat-sen University from July to November in 2018 were enrolled. The changes in antral contraction frequency (ACF), antral contraction amplitude (ACA) and antral motility index (MI) were dynamically observed at 1-6 days after injury by ultrasonography. According to Glasgow coma score (GCS), the patients were divided into moderate to severe craniocerebral (GCS ≤ 11) and mild craniocerebral injury groups (GCS > 11). The differences in ACF, ACA and MI between the two groups were compared to observe the effect of craniocerebral injury on gastric antral motility. The patients were divided into simple supratentorial and supratentorial combined infratentorial lesion groups according to the lesion location of craniocerebral injury. The differences in ACF, ACA and MI between the two groups were compared to analyze the influence of lesion location on gastric antrum activity. RESULTS: A total of 68 patients with craniocerebral injury were screened during the study period, 50 patients were in accorded with the admission criteria, 17 patients were withdrawn from the observation because they could not tolerate the ultrasonography of gastric antrum or discharged from ICU. Finally, 33 patients were enrolled in the analysis. (1) The ACF, ACA and MI at 1 day after injury were lower [ACF (times/min): 1.67 (0.00, 2.00), ACA: 42.06 (0.00, 44.45)%, MI: 0.70 (0.00, 0.87)], and then gradually increased, till 6 days after injury, ACF was 1.83 (1.25, 2.79) times/min, ACA was 56.80 (33.25, 60.77)%, and MI was 0.89 (0.50, 1.70), which showed no differences among all time points (all P > 0.05). (2) The contractile function of gastric antrum in two groups of patients with different degrees of craniocerebral injury was decreased, especially ACA in patients with moderate to severe craniocerebral injury (n = 22), which showed significant differences at 3 days and 5 days after injury as compared with mild craniocerebral injury [n = 11; 3 days: 35.05 (0.00, 53.69)% vs. 58.51 (49.90, 65.45)%, 5 days: 39.88 (0.00, 77.01)% vs. 56.94 (41.71, 66.66)%, both P < 0.05], indicating that the degree of craniocerebral injury affected the contractive function of gastric antrum. However, there was no significant difference in ACF or MI between the two groups at different time points after injury. (3) The contractile function of gastric antrum was decreased after craniocerebral injury in both groups of patients with different lesion locations of craniocerebral injury. The ACF, ACA, and MI at 3-4 days in patients with supratentorial combined infratentorial lesion (n = 12) were slightly lower than those in patients with simple supratentorial lesion [n = 21; 3 days: ACF (times/min) was 0.83 (0.00, 2.00) vs. 2.25 (0.00, 3.00), ACA was 35.05 (0.00, 53.60)% vs. 49.93 (0.00, 63.44)%, MI was 0.29 (0.00, 1.07) vs. 1.23 (0.00, 1.61); 4 days: ACF (times/min) was 1.42 (0.50, 2.63) vs. 2.00 (1.63, 2.63), ACA was 30.45 (21.69, 60.61)% vs. 43.29 (38.41, 53.35)%, MI was 0.50 (0.15, 1.45) vs. 0.97 (0.66, 1.28)] without statistical differences (all P > 0.05), indicating that the lesion location might not affect the contractive function of gastric antrum. CONCLUSIONS: In the early stage of craniocerebral injury, the contractile function of gastric antrum was decreased, and the more severe the craniocerebral injury, the worse contractive function of gastric antrum.


Assuntos
Traumatismos Craniocerebrais/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Contração Muscular/fisiologia , Antro Pilórico/fisiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/terapia , Hospitalização , Humanos , Unidades de Terapia Intensiva , Antro Pilórico/diagnóstico por imagem , Índices de Gravidade do Trauma , Ultrassonografia
12.
Pediatr Emerg Care ; 35(7): 506-508, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31206506

RESUMO

BACKGROUND: There is an increased emphasis on reducing exposure to ionizing radiation in pediatric patients. Guidelines from the Pediatric Emergency Care Applied Research Network help practitioners identify patients at low risk for clinically important traumatic brain injury after head injury. OBJECTIVES: We seek to determine whether the institution of a pediatric track staffed by pediatric emergency medicine physicians (PEMs) within a community emergency department (ED) impacts the overall utilization of head computed tomography (CT) on children younger than 15 years with head injury. METHODS: We used a retrospective cohort analysis of patients under the age of 15 years presenting to a community ED in the year before and the year of institution of a pediatric emergency track. Relative risk estimates were used to determine the risk of CT use associated with nonpediatric-trained emergency providers. RESULTS: The community ED saw 11,094 patients and 14,639 patients younger than 15 years in fiscal years 2014-2015 and 2015-2016, respectively. In the year before PEMs, there were 312 children younger than 15 years seen for head injury; 47.09% received head CTs. After PEM coverage, there were 396 children younger than 15 years seen for head injury; 17.17% received head CTs. Pediatric patients with head injury were 2.2 times more likely to receive CTs before the institution of the pediatric track (95% confidence interval, 1.8-2.6). CONCLUSION: The implementation of a pediatric emergency track demonstrated a significant decrease in CT utilization for head injury. Continued development of pediatric tracks in community EDs can lead to reduction of CTs.


Assuntos
Traumatismos Craniocerebrais/diagnóstico por imagem , Serviço Hospitalar de Emergência/organização & administração , Medicina de Emergência Pediátrica , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , California , Criança , Pré-Escolar , Mão de Obra em Saúde , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Admissão e Escalonamento de Pessoal , Guias de Prática Clínica como Assunto , Estudos Retrospectivos
13.
Radiología (Madr., Ed. impr.) ; 61(3): 204-214, mayo-jun. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-185292

RESUMO

La fractura de peñascos constituye una lesión común de la base del cráneo, y la mayoría son el resultado de traumatismos de alta energía. Su reconocimiento en politraumatizados puede realizarse en las tomografías computarizadas de cráneo y cervicales. Los hallazgos directos e indirectos suelen ser suficientes para establecer el diagnóstico. Su identificación es importante debido a que el hueso temporal contiene estructuras críticas, y es posible errar debido a la complejidad de esta región, y su insuficiente vigilancia. Este trabajo revisa los puntos clave anatómicos, la sistematización de los hallazgos radiológicos y las clasificaciones usadas en fracturas de hueso temporal. Cobra relevancia la identificación y descripción de los hallazgos relativos a estructuras importantes de esta región, la búsqueda de fracturas no visibles sospechadas por signos indirectos, y la identificación de estructuras anatómicas que pueden simular fracturas. Pierden valor las clasificaciones clásicas, aunque siguen condicionando el manejo terapéutico


Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with multiple trauma, these injuries can be detected on CT scans of the head and neck, where the direct and indirect signs are usually sufficient to establish the diagnosis. It is important to these fractures because the temporal bone has critical structures and the complexity of this region increases the risk of error unless special care is taken. This article reviews the key anatomical points, the systematization of the imaging findings, and the classifications used for temporal bone fracture. We emphasize the usefulness of identifying and describing the findings in relation to important structures in this region, of looking for unseen fractures suspected through indirect signs, and of identifying anatomical structures that can simulate fractures. We point out that the classical classifications of these fractures are less useful, although they continue to be used for treatment decisions


Assuntos
Humanos , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos do Nervo Facial/diagnóstico por imagem , Ossículos da Orelha/lesões , Lesões das Artérias Carótidas/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Traumatismo Múltiplo/diagnóstico por imagem , Perda Auditiva/etiologia
15.
J Nepal Health Res Counc ; 17(1): 56-60, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31110378

RESUMO

BACKGROUND: Head injury is a common problem encountered in emergency department. Among various neurological diseases, cranio-cerebral trauma ranks high in order of frequency and gravity. In acute setting, computed tomography is modality of choice because of its high accuracy in detecting intracranial lesions. The study was done to analyze computed tomography findings in cerebral trauma in regards to sociodemographic characteristics and find out associations of Computed tomography findings with mechanism of injury and clinical manifestations. METHODS: The study was carried in Department of Radiology, BPKIHS, over a period of one year from Aug. 2015 to Aug. 2016. 450 patients were included in our study and findings noted on structured pro forma. Analysis was done using SPSS version 20 applying simple descriptive statistical methods. RESULTS: Among 450 patients, 220 patients (48.9%) had various cranio-cerebral injuries. Most were in age group of 20-29 years (49.5%) and most common mode was road traffic accident (44.6%).Most patients presented with altered sensorium (39.2%) and Glasgow Coma Scale score of ?13 (70.9%). Scalp lesion was the most common finding (24%) followed by bone fractures (19.8 %). Patients with road traffic accident (59.7%) and fall from height (46.7%) had more positive computed tomography findings than from physical assault (28.2%). Glasgow Coma Scale showed significant statistical association with computed tomography findings (p<0.001). CONCLUSIONS: Road traffic accident is the most common mode of head injury in young adults patients presenting in our hospital. Glasgow Coma Scale can be considered as an important clinical marker for predicting positive computed tomography findings. Also computed tomography is an important initial investigation to evaluate the various craniocerebral injury in trauma patients.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/patologia , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/patologia , Estudos Transversais , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Neuroimagem , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/patologia , Centros de Atenção Terciária/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Adv Otorhinolaryngol ; 82: 111-118, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947165

RESUMO

Subjective complaints of dizziness after mild-to-moderate traumatic brain injury are common. Alterations in the mode of injury have changed the presentation symptoms. Evolutions in neuroimaging challenge conventional concepts regarding lack of evidence of injury following mild head trauma and provide hope for elucidating the site of lesion in patients with post-traumatic balance symptoms. Yet the vestibular clinician must maintain a healthy level of suspicion regarding potential exaggeration of symptoms and disability in patients with a financial incentive. Unique conditions warrant particular attention by the vestibular clinician, including chronic traumatic encephalopathy, catastrophization, and persistent postural and perceptual dizziness. The clinical significance of abnormalities, particularly on vestibular-evoked myogenic potential testing, needs to be better defined prior to their widespread application in the medical legal arena. The role of the medical expert is to provide opinion on matters requiring special knowledge to assist the court in reaching its findings. As such, this chapter provides an update on recent advances to consider in patients with dizziness after trauma.


Assuntos
Traumatismos Craniocerebrais/complicações , Tontura/etiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Diagnóstico Diferencial , Avaliação da Deficiência , Tontura/diagnóstico por imagem , Humanos , Jurisprudência , Testes de Função Vestibular
17.
Rev. medica electron ; 41(2): 368-381, mar.-abr. 2019. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1004274

RESUMO

RESUMEN Introducción: el traumatismo encefalocraneano es una causa frecuente de mortalidad y morbilidad. Según datos epidemiológicos aporta la mayor cantidad de fallecidos en menores de 45 años a nivel mundial. Objetivo: caracterizar el trauma craneoencefálico desde el punto de vista clínico-quirúrgico, neuroimagenológico y por neuromonitorización en los pacientes investigados. Materiales y métodos: estudio observacional, descriptivo, transversal, en el Servicio de Neurocirugía del Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane y Comandante Faustino Pérez Hernández, de Matanzas, durante el periodo comprendido entre enero del 2016 a enero del 2018. Resultados: predominó el sexo masculino con el 71,7% de los casos, la mayor prevalencia estuvo en edades inferiores a 48 años con el 80,1 %. La mayor cantidad presentaba un traumatismo encefalocraneano leve con el 56% de los casos seguido del traumatismo encefalocraneano moderado y severo con el 29% y 15% de los casos respectivamente. Predominaron las fracturas lineales (45,8%), seguido de las contusiones sin efecto de masa y los hematomas subdurales con el 24,2% y 23,3%. La mayoría de los pacientes presentó una escala de Marshall II con el 40,8%. Las cifras de presión intracraneal entre de 20-40 mmHg se presentó con mayor frecuencia (44,4 %). Conclusiones: la mitad de los pacientes neuromonitorizados presentaron una saturación del golfo de la vena yugular dentro de parámetros normales con el 50%. La operación más practicada fue la evacuación de hematomas subdurales con el 29,4%.


ABSTRACT Introduction: the encephalocranial trauma (ECT) is a frequent cause of mortality and morbidity. According to epidemiological data, it causes the highest number of deaths in people aged less than 45 years worldwide. Objective: to characterize the encephalocranial trauma from the clinical-surgical, neuroimaging and neuromonitoring point of view in the studied patients. Materials and methods: observational, descriptive, cross-sectional study carried out in the Neurosurgery Service of the Provincial Teaching Surgical Clinical Hospitals "Jose Ramon Lopez Tabrane" and "Comandante Faustino Perez Hernandez", of Matanzas, during the period from January 2016 to January 2018. Results: male sex predominated with 71.7% of the cases; the highest prevalence was in ages below 48 years with 80.1%. Most of them presented a mild encephalocranial trauma with 56% of the cases followed by moderate and severe encephalocranial trauma with 29% and 15% of the cases respectively. Linear fractures predominated (45.8%), followed by contusions without mass effect and subdural hematomas with 24.2% and 23.3%. Most of patients presented a Marshall II scale with 40.8%. The intracranial pressure between 20-40 mmHg occurred more frequently (44.4%). Conclusions: half of the neuromonitored patients presented jugular vein gulf saturation within normal parameters with 50%. The most practiced operation was the evacuation of subdural hematomas with 29.4%.


Assuntos
Humanos , Procedimentos Neurocirúrgicos , Tomografia Computadorizada Espiral , Traumatismos Craniocerebrais/cirurgia , Traumatismos Craniocerebrais/classificação , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Epidemiologia Descritiva , Estudos Transversais , Estudo Observacional , Traumatismos Craniocerebrais/diagnóstico
19.
Medicine (Baltimore) ; 98(11): e14732, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882640

RESUMO

This study aims to explore the principles of clinical classification and individualized treatment of basicranial artery injuries based on its anatomical correlation.The data of 172 patients with various types of basicranial artery injuries were retrospectively analyzed. Among these patients, 128 patients were male and 44 patients were female, and the average age of these patients was 28.3 years old. All patients underwent computed tomography, some patients underwent computed tomography angiography or magnetic resonance angiography, and all the diagnoses were confirmed by digital subtraction angiography (DSA). According to anatomical correlation, the injuries were classified into 5 types: vascular wall injury (type I), intradural injury (type II), epidural injury (type III), sinus injury (type IV), and skull base bone injury (type V). Individualized treatment was adopted based on the different types and characteristics of injuries.The percentages of basicranial artery injuries were as follows: type I, 4.6%; type II, 5.8%; type III, 3.5%; type IV, 77.9%; and type V, 8.1%. All 172 patients underwent DSA to demonstrate the classification. The lesion elimination rate revealed by DSA was 99.4% immediately after the operation, 98.3% at 1 week after the operation, and 98.8% at 3 months after the operation. The follow-up after 6 months revealed that the percentage of patients in whom clinical symptoms or signs completely disappeared was 97.7%, the percentage of patients with limited eye movement or visual impairment was 1.2%, and the percentage of patients with mild limb dysfunction was 0.6%.Basicranial artery injuries can be classified into 5 types. Individualized design of embolization therapy based on different characteristics might be applicable for basicranial artery injuries treatment.


Assuntos
Fístula Carotidocavernosa/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Lesões do Sistema Vascular/diagnóstico por imagem , Adulto , Fístula Carotidocavernosa/etiologia , Angiografia por Tomografia Computadorizada , Traumatismos Craniocerebrais/complicações , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Lesões do Sistema Vascular/classificação
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