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101. Head and neck imaging

patient outcomes based on current literature and/or standards of medical practice; or ? Appropriateness of additional imaging is dependent on the results of the lead study. When multiple imaging studies are ordered, the request will often require a peer-to-peer conversation to understand the individual circumstances that support the medically necessity of performing all imaging studies simultaneously. Examples of multiple imaging studies that may require a peer-to-peer conversation include: ? CT brain (...) and CT sinus for headache ? MRI brain and MRA brain for headache ? MRI cervical spine and MRI shoulder for pain indications ? MRI lumbar spine and MRI hip for pain indications ? MRI or CT of multiple spine levels for pain or radicular indications ? MRI foot and MRI ankle for pain indications ? Bilateral exams, particularly comparison studies There are certain clinical scenarios where simultaneous ordering of multiple imaging studies is consistent with current literature and/or standards of medical

2019 AIM Specialty Health

102. Extremity imaging

avulsion (Pediatric only) 17 Trauma complications (Pediatric only) 17 Traumatic injuries – acute/not otherwise specified 17 Tumor/Neoplasm 18 Imaging of the Extremities Copyright © 2019. AIM Specialty Health. All Rights Reserved. 3 Brachial plexus mass 18 Morton’s neuroma 18 Osteochondroma or exostosis (Pediatric only) 18 Osteoid osteoma (Pediatric only) 18 Pigmented villonodular synovitis 18 Posterior knee mass (Adult only) 19 Soft tissue mass – not otherwise specified 19 Ligament and Tendon (...) Derangement 20 Adhesive capsulitis (Adult only) 20 Labral tear – hip 20 Labral tear – shoulder 21 Ligament tear – knee 22 Meniscal tear/injury 22 Rotator cuff tear (Adult only) 23 Tendon injuries-foot and ankle 24 Tendon rupture – biceps or triceps 24 Tendon rupture – foot and ankle 25 Triangular fibrocartilage complex tear 25 Ulnar collateral ligament tear (elbow or thumb) 25 Ligament and tendon injuries not listed elsewhere 25 Miscellaneous Joint Conditions 26 Avascular necrosis 26 Chondromalacia

2019 AIM Specialty Health

103. AIM Clinical Appropriateness Guidelines for Radiation Oncology

) is appropriate for bone metastases when ANY one of the following conditions are met: ? Pain at the site of metastasis ? Lytic lesion involving a weight bearing bone ? Spinal cord compression ? Post-operative treatment following surgical stabilization Intensity Modulated Radiation Therapy (IMRT) is appropriate for bone metastases when ALL of the following conditions are met: ? To treat a previously irradiated field ? Re-treatment with EBRT would result in significant risk of spinal cord injury (e.g cumulative (...) spinal cord dose >50 Gy in 2 Gy equivalent) Stereotactic Radiosurgery (SRS) or Stereotactic Body Radiotherapy (SBRT) is appropriate for bone metastasis when ALL of the following conditions are met: ? To treat a previously irradiated field ? Re-treatment with EBRT would result in significant risk of spinal cord injury (e.g cumulative spinal cord dose >50 Gy in 2 Gy equivalent) Fractionation Single fraction treatment is appropriate in individuals who meet ANY of the following criteria: ? Poor

2019 AIM Specialty Health

104. Peri-operative care of people with dementia. Online Supporting Information

). • The e-Learning for Healthcare (e-LFH) website has a specific e-Learning for anaesthesia module covering dementia and delirium and a generic e-LfH module on dementia. (accessed 20/02/2018). • American Society of Anesthesiologists. Peri-operative brain health initiative. Due to launch formally in 2018, this will provide an online resource for individual clinicians and their hospital to minimise the impact of inpatient surgical stay on older patients with cognitive (...) , guarding part of body, withdrawn Absent 0, Mild 1, Moderate 2, Severe 3 BEHAVIOURAL CHANGES e.g. increased confusion, refusing to eat, alteration in usual patterns Absent 0, Mild 1, Moderate 2, Severe 3 PHYSIOLOGICAL CHANGES e.g. temperature, HR or BP outside normal limits, perspiring, flushing, pallor Absent 0, Mild 1, Moderate 2, Severe 3 PHYSICAL CHANGES e.g. skin tears, pressure areas, arthritis, contractures, previous injuries Absent 0, Mild 1, Moderate 2, Severe 3 TOTAL PAIN SCORE Chronic pain

2019 Association of Anaesthetists of GB and Ireland

105. Migraine and Tension Headache

and treatment. Populations excluded from this guideline include pregnant women and children aged 13 years and younger. Note: KPWA and national guidelines advise against the use of opioids and butalbital-containing medications (e.g., fiorinal, fioricet) for treatment of headaches. Diagnosis Red flag warning signs For patients with a rapidly accelerating course, a recent history of head injury, or focal neurologic findings, consult with a neurologist or neurosurgeon. Use the SNOOP mnemonic to identify red (...) migraine? 9. What is the clinical effectiveness of corticosteroids, tricyclics, and withdrawal strategies (of abortive treatments) for the treatment of medication overuse headache? 10. Is it useful for patients with suspected primary headaches to undergo brain imaging for reassurance or to detect underlying pathology? 11. What is the efficacy and safety of the Cefaly device for migraine? External guidelines meeting KPWA criteria for adaptation/adoption 2015 American Headache Society. Marmura MJ

2018 Kaiser Permanente Clinical Guidelines

106. ESC/ESH Management of Arterial Hypertension

5.3 Physical examination and clinical investigations3042 5.4 Assessment of hypertension-mediated organ damage3042 5.4.1 Using hypertension-mediated organ damage to help stratify risk in hypertensive patients3042 5.5 Characteristics of hypertension-mediated organ damage3044 5.5.1 The heart in hypertension3044 5.5.2 The blood vessels in hypertension3044 5.5.3 The kidney in hypertension3045 5.5.4 Hypertensive retinopathy3045 5.5.5 The brain in hypertension3045 5.6 Hypertension-mediated organ damage (...) ARB Angiotensin receptor blocker ASCOT Anglo-Scandinavian Cardiac Outcomes Trial AV Atrioventricular BMI Body mass index BP Blood pressure bpm Beats per minute BSA Body surface area CAD Coronary artery disease CAPPP Captopril Prevention Project CCB Calcium channel blocker CHA2DS2-VASc Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65–74 years, Sex category (female) CKD Chronic kidney disease CK-MB Creatinine kinase-muscle/brain CMR Cardiac

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2018 European Society of Cardiology

107. Intrapartum fetal surveillance

aim of intrapartum fetal surveillance is to prevent adverse perinatal outcomes arising from fetal metabolic acidosis related to labour. 2 As the fetal brain modulates the fetal heart rate (FHR) through an interplay of sympathetic and parasympathetic forces, fetal heart rate monitoring can be used as an indicator of whether or not a fetus is well oxygenated. 3 In the absence of risk factors FHR surveillance by continuous electronic fetal monitoring (CEFM) does not provide proven benefit and may (...) and Care Excellence. Interpretation of cardiotoograph traces. Clinical Guideline No. 190. 2014. 23. Stampalija T, Signaroldi M, Mastroianni C, Rosti E, Signorelli V, Casati D, et al. Fetal and maternal heart rate confusion during intra-partum monitoring: comparison of trans-abdominal fetal electrocardiogram and doppler telemetry. Journal of Maternal-Fetal and Neonatal Medicine 2012;25(8):1517-20. 24. Miyashiro M, Mintz-Hittner H. Penetrating ocular injury with a fetal scalp monitoring spiral electrode

2019 Queensland Health

108. Clinical Practice Guideline for the Management of Infantile Hemangiomas

can also be a complication of multifocal or diffuse hepatic IHs. Although liver IHs can occasionally be seen in infants with 1 or no IH of the skin, the greatest risk for liver IHs is in infants who have 5 or more cutaneous IHs, for whom screening ultrasonography is recommended (see KAS 2A). , Other sites of extracutaneous hemangiomas can occur, including the gastrointestinal tract, brain, and other organs. However, such involvement is rare and occurs mostly in association with large segmental IHs (...) ” is sometimes used instead to include potential ventral midline defects, specifically sternal cleft and/or supraumbilical raphe. Cerebrovascular anomalies, present in more than 90% of patients with PHACE syndrome, are the most common extracutaneous feature of the syndrome, followed by cardiac anomalies (67%) and structural brain anomalies (52%). The hallmark of PHACE syndrome is a large (often >5 cm in diameter) segmental IH that typically involves the face, scalp, and/or neck, although in rare cases

2019 American Academy of Pediatrics

109. Spinal Injections Coverage Decision

signals to the brain mediated by the nerve(s) are interrupted. A diagnostic medial branch block is used to identify which nerve(s), if destroyed, could relieve the pain. Refer to the facet neurotomy guideline before planning a medial branch block. Therapeutic Therapeutic medial branch blocks are not covered because they are not effective in relieving pain. Note: CPT codes are the same for medial branch block injections regardless of their purpose; however, only diagnostic medial branch blocks (...) . Selective Nerve Root Blocks (SNRBs) SNRBs may be used when a worker has had 6 weeks of conservative care and still has radicular pain with positive imaging findings, but does not have the objective signs of motor, reflex or EMG changes. Use SNRBs only when: • The worker has clear sensory symptoms indicative of radiculopathy or nerve root irritation, and • The worker’s symptoms and exam findings are consistent with injury or irritation of the nerve root that is to be blocked; and • Injury or irritation

2019 Washington State Department of Labor and Industries

110. Professional Practice Guidelines for the Psychological Practice with Boys and Men

to understanding military culture, hier- archy, and reintegration issues, psycholo- gists strive to recognize the connections between military service, masculinities, and common mental health concerns such as post-traumatic stress disorder, traumat- ic brain injury, substance-related disorders, APA | Guidelines for Psychological Practice with Boys and Men 9 depression, anxiety, and suicidal ideation, as well as psychological help-seeking (Leppma et al., 2016; Jakupcak, Primack, & Solimeo, 2017). Psychologists (...) they may face from peers (Kosciw, Greytak, Giga, Villenas, & Danischewski, 2016). These experiences may lead to mental health problems, including depres- sive symptoms (Dank, Lachman, Zweig, & Yahner, 2014), self-injury (dickey, Reisner, & Juntunen, 2015) and suicidality (Clements- Nolle, Marx, & Katz, 2006). Furthermore, policing of masculinity expression in boys by their caregivers tends to be ineffective and emotionally damaging to the child, and creates tension in the relationship (Hill & Menvielle

2019 American Psychological Association

111. Suspected Spine Trauma ? Child

cervical spine injury in children with severe traumatic brain injury. J Trauma Acute Care Surg 2015;78:1122-8. 62. Satahoo SS, Davis JS, Garcia GD, et al. Sticking our neck out: is magnetic resonance imaging needed to clear an obtunded patient's cervical spine? J Surg Res 2014;187:225-9. 63. Steigelman M, Lopez P, Dent D, et al. Screening cervical spine MRI after normal cervical spine CT scans in patients in whom cervical spine injury cannot be excluded by physical examination. Am J Surg 2008;196:857 (...) . Bromberg WJ, Collier BC, Diebel LN, et al. Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. J Trauma 2010;68:471-7. ACR Appropriateness Criteria ® 16 Suspected Spine Trauma–Child 87. Agrawal D, Sinha TP, Bhoi S. Assessment of ultrasound as a diagnostic modality for detecting potentially unstable cervical spine fractures in pediatric severe traumatic brain injury: A feasibility study. J Pediatr Neurosci 2015;10:119-22. 88. Machino M, Yukawa

2019 American College of Radiology

112. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association

transplants. The risk of statin-induced serious muscle injury, including rhabdomyolysis, is <0.1%, and the risk of serious hepatotoxicity is ≈0.001%. The risk of statin-induced newly diagnosed diabetes mellitus is ≈0.2% per year of treatment, depending on the underlying risk of diabetes mellitus in the population studied. In patients with cerebrovascular disease, statins possibly increase the risk of hemorrhagic stroke; however, they clearly produce a greater reduction in the risk of atherothrombotic (...) presenting with significant unexplained muscle symptoms or unexplained increases above 3 times the ULN in transaminases, because these enzymes are found in muscle and liver. Failing to measure CK can result in missing a diagnosis of myopathy, which is likely to progress to rhabdomyolysis and possibly acute kidney injury (AKI) if the statin is not stopped. Drug interactions (considered in more detail in 3. Drug-Drug Interactions) are a common cause of elevated CK and myopathy/rhabdomyolysis and should

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2019 American Gastroenterological Association Institute

113. Acute Mental Status Change, Delirium, and New Onset Psychosis

, encephalopathy, disorientation, lethargy, drowsiness, somnolence, unresponsiveness, coma, agitation, altered behavior, inattention, hallucinations, delusions, psychosis, or behaving inappropriately [3,4]. Acute mental status changes occur over minutes to days and may be triggered by a wide range of medical conditions, including drugs, intoxication, system or organ dysfunction, metabolic or endocrine factors, and neurological processes that include traumatic brain injury and cerebrovascular disease [3]. Less (...) : a collection of easily missed findings that are life-threatening or life-changing. J Emerg Med 2014;47:646-59. 36. Granata RT, Castillo EM, Vilke GM. Safety of deferred CT imaging of intoxicated patients presenting with possible traumatic brain injury. Am J Emerg Med 2017;35:51-54. 37. Sparacia G, Anastasi A, Speciale C, Agnello F, Banco A. Magnetic resonance imaging in the assessment of brain involvement in alcoholic and nonalcoholic Wernicke's encephalopathy. World J Radiol 2017;9:72-78. 38. Hardy JE

2019 American College of Radiology

114. Clinical Practice Guideline: Maintenance Intravenous Fluids in Children

hyponatremia in patients who are hospitalized is hospital acquired and related to the administration of hypotonic IVFs in the setting of elevated AVP concentrations. , Studies in which researchers evaluated hospital‐acquired hyponatremia have revealed a relationship with the administration of hypotonic IVFs. , , The most serious complication of hospital-acquired hyponatremia is hyponatremic encephalopathy, which is a medical emergency that can be fatal or lead to irreversible brain injury if inadequately (...) of their larger brain/skull size ratio. Symptoms of hyponatremia can be nonspecific, including fussiness, headache, nausea, vomiting, confusion, lethargy, and muscle cramps, making prompt diagnosis difficult. After reports of severe hyponatremia and associated neurologic injury were reported in 1992, a significant debate emerged regarding the appropriateness of administering hypotonic maintenance IVFs to children. In 2003, it was recommended that isotonic fluids be administered to children who are acutely ill

2019 American Academy of Pediatrics

115. Thyroid Function Testing in the Diagnosis and Monitoring of Thyroid Function Disorder

, injuries, vascular accidents, autoimmune disease, infiltrative disease, congenital conditions and infections. 11 If central hypothyroidism is being investigated “suspicion of pituitary insufficiency” should be included as a clinical indication and a request for fT4 (with or without TSH) should be indicated in the space provided on the standard out-patient laboratory requisition (see Appendix 1: BC Laboratory Algorithm for Thyroid Tests). A TSH value within the laboratory reference interval excludes (...) . Association of maternal thyroid function during early pregnancy with offspring IQ and brain morphology in childhood: a population-based prospective cohort study. Lancet Diabetes Endocrinol. 2016 Jan 1;4(1):35–43. Abbreviations fT4 Free thyroxine fT3 Free triiodothyronine hCG human chorionic gonadotropin TPO Thyroid peroxidase TSH Thyroid stimulating hormone Diagnostic Codes: 244 (Hypothyroidism), 242 (Hyperthyroidism) Appendices • Appendix 1: BC Laboratory Algorithm for Thyroid Tests This guideline

2018 Clinical Practice Guidelines and Protocols in British Columbia

116. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of PCOS in Adolescence

alterations. In fact, central insulin actions are indispensable for proper functioning of the gonadotropic axis in mice; lack of brain insulin signaling decreases LH levels and disturbs follicular maturation [ ]. In good agreement, insulin infusion in control women increased LH pulse frequency, reminiscent of secretory profiles of women with PCOS [ ]. In fact, lean patients with PCOS have been shown to display increased basal LH levels and LH:FSH ratios. Yet, another study involving women with PCOS (...) reported that insulin administration failed to alter LH pulsatility [ ]. The mechanisms responsible for the effects of high insulin levels on the GnRH pulse generator need further elucidation. Insulin receptors in GnRH neurons appear dispensable for proper pubertal maturation and fertility, therefore pointing to a primary action of insulin at other brain targets, likely occurring upstream of the GnRH neurons [ ]. Studies in sheep and rodents suggest that insulin signaling may modulate Kiss1 neuron

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2019 Pediatric Endocrine Society

117. Headache

[118]. Post-traumatic Headache Post-traumatic headache (PTH) is defined by the 2nd edition of the International Classification of Headache Disorders as headache that begins within a week of trauma. Both acute (APTH) and chronic (CPTH) begin within 7 days of the injury, and CPTH persists for more than 3 months. Headache is among the most prominent of the symptoms that may linger after mild traumatic brain injury (TBI). The Centers for Disease Control reports that TBI results in nearly 1.4 million (...) with GRE, FLAIR, SWI, and DWI are reserved for severe acute head ACR Appropriateness Criteria ® 17 Headache trauma and in cases where the patient is much worse on clinical examination than can be explained by CT results. MRI is the primary imaging modality for evaluating delayed effects of brain injury. Furthermore, if MRI and CT are negative but neuropsychological evaluation identifies impairment of mood, executive function, or cognitive endurance, then diffusion tensor imaging might be indicated

2019 American College of Radiology

118. Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice

of age. , , In addition to primary associations with poor long-term outcomes for the child, untreated perinatal depression is also strongly tied with other unfavorable states and events that may add to the adverse effect on a child’s overall health and development, including the following: child abuse and neglect; failure to implement the injury-prevention components from anticipatory guidance (eg, car safety seat and electrical plug covers) , ; failure to implement preventive health practices (...) . The adverse effect of accumulating ACEs on child development may be mediated through the development of toxic stress, or the state of excessive, persistent, repetitive, and/or uncontrollable adversity without the buffering of a safe, stable, nurturing, and responsive parent to promote adaptive coping. Over time, toxic stress has consequences on brain architecture and disrupts multiple organ systems through chronic activation of stress hormone responses, cytokines, and immune modulators. The association

2019 American Academy of Pediatrics

119. ACR–ASNR–ASSR–SPR Practice Parameter for the Performance of Computed Tomography (CT) of the Spine

the prognostic value of four imaging modalities in clearing the cervical spine for children with severe traumatic injuries. Childs Nerv Syst. 2012;28(5):699-705. 36. Cullen A, Terris M, Ford R. Spinal clearance in unconscious children following traumatic brain injury. Paediatr Anaesth. 2014;24(7):711-716. 37. Egloff AM, Kadom N, Vezina G, Bulas D. Pediatric cervical spine trauma imaging: a practical approach. Pediatr Radiol. 2009;39(5):447-456. 38. Gargas J, Yaszay B, Kruk P, Bastrom T, Shellington D, Khanna (...) S. An analysis of cervical spine magnetic resonance imaging findings after normal computed tomographic imaging findings in pediatric trauma patients: ten-year experience of a level I pediatric trauma center. J Trauma Acute Care Surg. 2013;74(4):1102-1107. 39. Kadom N, Khademian Z, Vezina G, Shalaby-Rana E, Rice A, Hinds T. Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma. Pediatr Radiol. 2014;44(7):839- 848. 40. Mortazavi M, Gore PA, Chang

2019 American Society of Neuroradiology

120. ACR–ASNR–SPR Practice Parameter for the Performance of Computed Tomography (CT) Perfusion in Neuroradiologic Imaging Revised

in the setting of acute traumatic brain injury [43,44] and in the setting of acute seizures [45] vii. Assessment of neoplastic disease [24,46-49] viii. In patients with contraindication to magnetic resonance imaging (MRI)–based perfusion imaging or with devices or material in or close to the field of view that would result in nondiagnostic MRI scans. 2. Head and neck [50] a. Primary indications: Evaluation of the vascular status of solid tumors where MRI is degraded due to susceptibility artifact from air (...) for acute ischemic stroke, vascular malformations, and other indications is not yet defined. Diagnostic pitfalls include small and chronic infarcts, severe microvascular ischemia, extracranial and intracranial stenosis, and mimicking conditions such as vasospasm, traumatic brain injuries, and seizures [12,94-96]. V. DOCUMENTATION Reporting should be in accordance with the ACR Practice Parameter for Communication of Diagnostic Imaging Findings [97]. The type and amount of contrast injected

2019 American Society of Neuroradiology


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