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Management of Mild Head Injury

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1. Can S100B Serum Biomarker Testing Reduce Head Computed Tomography Scanning in Children With Mild Traumatic Brain Injury?

and low positive predictive value, thus somewhat limiting its ability to reduce the number of CT scans and hospital costs. x 8 Ruan, S., Noyes, K., and Bazarian, J.J. The economic impact of S-100B as a pre-head CT screening test on emergency department management of adult patients with mild traumatic brain injury. J Neurotrauma . 2009 ; 26 : 1655–1664 In addition, many facilities may not have immediate access to the results of the test, with personal experience showing a turnaround time of 3 to 18 (...) Can S100B Serum Biomarker Testing Reduce Head Computed Tomography Scanning in Children With Mild Traumatic Brain Injury? Can S100B Serum Biomarker Testing Reduce Head Computed Tomography Scanning in Children With Mild Traumatic Brain Injury? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 73, Issue 5, Pages 456–458 Can S100B Serum Biomarker Testing Reduce Head Computed Tomography Scanning

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2019 Annals of Emergency Medicine Systematic Review Snapshots

2. Blood-Based Protein Biomarkers for the Management of Traumatic Brain Injuries in Adults Presenting with Mild Head Injury to Emergency Departments: A Living Systematic Review and Meta-Analysis. (PubMed)

Blood-Based Protein Biomarkers for the Management of Traumatic Brain Injuries in Adults Presenting with Mild Head Injury to Emergency Departments: A Living Systematic Review and Meta-Analysis. Accurate diagnosis of traumatic brain injury (TBI) is critical to effective management and intervention, but can be challenging in patients with mild TBI. A substantial number of studies have reported the use of circulating biomarkers as signatures for TBI, capable of improving diagnostic accuracy (...) and clinical decision making beyond current practice standards. We performed a systematic review and meta-analysis to comprehensively and critically evaluate the existing body of evidence for the use of blood protein biomarkers (S100 calcium binding protein B [S100B], glial fibrillary acidic protein [GFAP], neuron specific enolase [NSE], ubiquitin C-terminal hydrolase-L1 [UCH-L1]. tau, and neurofilament proteins) for diagnosis of intracranial lesions on CT following mild TBI. Effects of potential

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2017 Journal of neurotrauma

3. External validation of the Scandinavian guidelines for management of minimal, mild and moderate head injuries in children. (PubMed)

External validation of the Scandinavian guidelines for management of minimal, mild and moderate head injuries in children. Clinical decision rules (CDRs) aid in the management of children with traumatic brain injury (TBI). Recently, the Scandinavian Neurotrauma Committee (SNC) has published practical, evidence-based guidelines for children with Glasgow Coma Scale (GCS) scores of 9-15. This study aims to validate these guidelines and to compare them with other CDRs.A large prospective cohort (...) of children (< 18 years) with TBI of all severities, from ten Australian and New Zealand hospitals, was used to assess the SNC guidelines. Firstly, a validation study was performed according to the inclusion and exclusion criteria of the SNC guideline. Secondly, we compared the accuracy of SNC, CATCH, CHALICE and PECARN CDRs in patients with GCS 13-15 only. Diagnostic accuracy was calculated for outcome measures of need for neurosurgery, clinically important TBI (ciTBI) and brain injury on CT.The SNC

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2018 BMC Medicine

4. Economic evaluation of the NET intervention versus guideline dissemination for management of mild head injury in hospital emergency departments. (PubMed)

Economic evaluation of the NET intervention versus guideline dissemination for management of mild head injury in hospital emergency departments. Evidence-based guidelines for the management of mild traumatic brain injury (mTBI) in the emergency department (ED) are now widely available, and yet, clinical practice remains inconsistent with the guidelines. The Neurotrauma Evidence Translation (NET) intervention was developed to increase the uptake of guideline recommendations and improve (...) the management of minor head injury in Australian emergency departments (EDs). However, the adoption of this type of intervention typically entails an upfront investment that may or may not be fully offset by improvements in clinical practice, health outcomes and/or reductions in health service utilisation. The present study estimates the cost and cost-effectiveness of the NET intervention, as compared to the passive dissemination of the guideline, to evaluate whether any improvements in clinical practice

2018 Implementation Science Controlled trial quality: predicted high

5. Management of Concussion-mild Traumatic Brain Injury (mTBI)

• Neurological deficit: motor or sensory • Double vision • Worsening headache • Cannot recognize people or disoriented to place • Slurred speech • Unusual behaviorVA/DoD Clinical Practice Guideline for the Management of Concussion-mild Traumatic Brain Injury February 2016 Page 23 of 133 Evaluating individuals in military operational settings who are exposed to potentially concussive events (e.g., blast, motor vehicle accidents, blow to the head) while in theater is strongly encouraged as soon as possible (...) Management of Concussion-mild Traumatic Brain Injury (mTBI) VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF CONCUSSION-MILD TRAUMATIC BRAIN INJURY Department of Veterans Affairs Department of Defense QUALIFYING STATEMENTS The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision making. They are not intended to define a standard

2016 VA/DoD Clinical Practice Guidelines

6. Intact mast cell content during mild head injury is required for development of latent pain sensitization: implications for mechanisms underlying post-traumatic headache. (PubMed)

Intact mast cell content during mild head injury is required for development of latent pain sensitization: implications for mechanisms underlying post-traumatic headache. Post-traumatic headache (PTH) is one of the most common, debilitating and difficult symptoms to manage after a traumatic head injury. While the mechanisms underlying PTH remain elusive, recent studies in rodent models suggest the potential involvement of calcitonin gene-related peptide (CGRP), a mediator of neurogenic (...) inflammation, and the ensuing activation of meningeal mast cells (MCs), pro-algesic resident immune cells that can lead to the activation of the headache pain pathway. Here, we investigated the relative contribution of MCs to the development of PTH-like pain behaviors in a model of mild closed head injury (mCHI) in male rats. We initially tested the relative contribution of peripheral CGRP signaling to the activation of meningeal MCs following mCHI using a blocking anti-CGRP monoclonal antibody. We

2019 Pain

7. Trauma Bay Disposition of Infants and Young Children With Mild Traumatic Brain Injury and Positive Head Imaging. (PubMed)

Trauma Bay Disposition of Infants and Young Children With Mild Traumatic Brain Injury and Positive Head Imaging. To describe the disposition of infants and young children with isolated mild traumatic brain injury and neuroimaging findings evaluated at a level 1 pediatric trauma center, and identify factors associated with their need for ICU admission.Retrospective cohort.Single center.Children less than or equal to 4 years old with mild traumatic brain injury (Glasgow Coma Scale 13-15 (...) included ICU (48%), ward (38%), intermediate care unit and home (7% each). Overall, 1% required intubation, 4.3% seizure management, and 4.3% neurosurgical procedures; 15% were diagnosed with nonaccidental trauma. None of the ward/intermediate care unit patients were transferred to ICU. Median ICU/hospital length of stay was 2 days. Most patients (99%) were discharged home without neurologic deficits. The ICU subgroup included all patients with midline shift, 62% patients with intracranial hemorrhage

2019 Pediatric Critical Care Medicine

8. Systematic Review - Relationship of Deployment-related Mild Traumatic Brain Injury to Posttraumatic Stress Disorder, Depressive Disorders, Substance Use Disorders, Suicidal Ideation, and Anxiety Disorders

Systematic Review - Relationship of Deployment-related Mild Traumatic Brain Injury to Posttraumatic Stress Disorder, Depressive Disorders, Substance Use Disorders, Suicidal Ideation, and Anxiety Disorders 4 March 2019 Prepared for: Department of Veterans Affairs Veterans Health Administration Health Services Research & Development Service Washington, DC 20420 Prepared by: Evidence Synthesis Program (ESP) Center Portland VA Medical Center Portland, OR Mark Helfand, MD, MPH, MS, Director (...) Relationship of Deployment-related Mild Traumatic Brain Injury to Posttraumatic Stress Disorder, Depressive Disorders, Substance Use Disorders, Suicidal Ideation, and Anxiety Disorders: A Systematic Review Authors: Principal Investigator: Nancy Greer, PhD Timothy J. Wilt, MD, MPH Co-Investigators: Princess Ackland, PhD, MSPH Roderick MacDonald, MS Nina Sayer, PhD Michele Spoont, PhD Brent Taylor, PhD Research Assistants: Lauren McKenzie, MPH Christina Rosebush, MPH Evidence Synthesis Program 4 Relationship

2019 Veterans Affairs Evidence-based Synthesis Program Reports

9. Mild Head Injury Home Management

Mild Head Injury Home Management Mild Head Injury Home Management Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Mild Head Injury (...) Home Management Mild Head Injury Home Management Aka: Mild Head Injury Home Management , Mild Head Injury Discharge Instructions , Head Injury Precautions From Related Chapters II. Management Follow-up One week follow-up clinic (or immediately if warning signs occur as below) Consider clinic (sports medicine) ral precautions Avoid and sedating medications for 3 days Remain with a reliable companion for 24 hours Avoid driving for at least the first 24 hours (and until most significant symptoms have

2018 FP Notebook

10. Management of Mild Head Injury

Management of Mild Head Injury Management of Mild Head Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Management of Mild Head (...) Injury Management of Mild Head Injury Aka: Management of Mild Head Injury , Mild Traumatic Brain Injury , MTBI , Minor Head Injury , Mild Head Injury , Mild Head Trauma From Related Chapters II. Epidemiology Mild Traumatic Brain Injury (MTBI) accounts for 75% of the 1.7 Million people in U.S. who suffer TBI annually III. Criteria : 13-15 (at two hours) Loss of consciousness may have occurred with injury Awake and oriented with normal ination IV. History See Time and mechanism of injury Loss

2018 FP Notebook

11. The addition of S100B to guidelines for management of mild head injury is potentially cost saving. (PubMed)

The addition of S100B to guidelines for management of mild head injury is potentially cost saving. Mild traumatic brain injury (TBI) is associated with substantial costs due to over-triage of patients to computed tomography (CT) scanning, despite validated decision rules. Serum biomarker S100B has shown promise for safely omitting CT scans but the economic impact from clinical use has never been reported. In 2007, S100B was adapted into the existing Scandinavian management guidelines (...) in Halmstad, Sweden, in an attempt to reduce CT scans and save costs.Consecutive adult patients with mild TBI (GCS 14-15, loss of consciousness and/or amnesia), managed with the aid of S100B, were prospectively included in this study. Patients were followed up after 3 months with a standardized questionnaire. Theoretical and actual cost differences were calculated.Seven hundred twenty-six patients were included and 29 (4.7 %) showed traumatic abnormalities on CT. No further significant intracranial

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2016 BMC Neurology

12. Evaluation of a targeted, theory-informed implementation intervention designed to increase uptake of emergency management recommendations regarding adult patients with mild traumatic brain injury: results of the NET cluster randomised trial. (PubMed)

intervention (Neurotrauma Evidence Translation (NET) intervention) was designed to increase the uptake of three clinical practice recommendations regarding the management of patients who present to Australian EDs with mild head injuries. The intervention involved local stakeholder meetings, identification and training of nursing and medical local opinion leaders, train-the-trainer workshops and standardised education materials and interactive workshops delivered by the opinion leaders to others within (...) Evaluation of a targeted, theory-informed implementation intervention designed to increase uptake of emergency management recommendations regarding adult patients with mild traumatic brain injury: results of the NET cluster randomised trial. Evidence-based guidelines for management of mild traumatic brain injury (mTBI) in the emergency department (ED) are now widely available; however, clinical practice remains inconsistent with these guidelines. A targeted, theory-informed implementation

2019 Implementation Science Controlled trial quality: predicted high

13. rTMS Treatment of Persistent Headache and Post Concussion Symptoms Attributed to Mild Traumatic Injury to the Head

rTMS Treatment of Persistent Headache and Post Concussion Symptoms Attributed to Mild Traumatic Injury to the Head rTMS Treatment of Persistent Headache and Post Concussion Symptoms Attributed to Mild Traumatic Injury to the Head - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number (...) of saved studies (100). Please remove one or more studies before adding more. rTMS Treatment of Persistent Headache and Post Concussion Symptoms Attributed to Mild Traumatic Injury to the Head (TOPiCS-rTMS) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03691272 Recruitment Status : Active

2018 Clinical Trials

14. Should Adults With Mild Head Injury Who Are Receiving Direct Oral Anticoagulants Undergo Computed Tomography Scanning? A Systematic Review. (PubMed)

Should Adults With Mild Head Injury Who Are Receiving Direct Oral Anticoagulants Undergo Computed Tomography Scanning? A Systematic Review. Patients receiving direct oral anticoagulant medications commonly undergo computed tomography head scanning after mild traumatic brain injury, regardless of symptoms or signs. International guidelines have noted a lack of evidence to support management decisions for such patients. This systematic review aims to identify, appraise, and synthesize the current (...) evidence for the risk of adverse outcome in patients receiving direct oral anticoagulants after mild head injury.A protocol was registered with PROSPERO and review methodology followed Cochrane Collaboration recommendations. Studies of adult patients with mild head injury (Glasgow Coma Scale score 13 to 15) and who were receiving direct oral anticoagulants that reported the risk of adverse outcome after the head injury were eligible for inclusion. A comprehensive range of bibliographic databases

2018 Annals of Emergency Medicine

15. The Incidence and Management of Moderate to Severe Head Injury. (PubMed)

The Incidence and Management of Moderate to Severe Head Injury. The comprehensive expansion of the Trauma Register of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie; TR-DGU) now enables, for the first time, studies on traumatic brain injury (TBI) with special attention to care processes, clinical course, and outcomes of treatment on discharge or transfer from the acute-care hospital.Retrospective analysis of patients documented in the TR-DGU in the period 2013-2017 who had (...) moderate to severe head injury as defined by the Abbreviated Injury Scale (AIS).In the period 2013-2017, 41 101 patients with moderate to severe TBI were treated in TR-DGU-associated hospitals in Germany (n = 605 hospitals), corresponding to 8220 cases per year and thus to a population-wide incidence of 10.1 cases per 100 000 persons per year. TBI was present as an isolated injury in 39.1% of cases. The mean age of the patients was 60 years (median; range 0-104 years), and the male-to-female ratio

2019 Deutsches Arzteblatt international

16. Mild fetal ventriculomegaly: diagnosis, evaluation, and management

Mild fetal ventriculomegaly: diagnosis, evaluation, and management Mild fetal ventriculomegaly: diagnosis, evaluation, and management Society for Maternal-Fetal Medicine (SMFM); Nathan S. Fox, MD; Ana Monteagudo, MD; Jeffrey A. Kuller, MD; Sabrina Craigo, MD; and Mary E. Norton, MD Thepracticeofmedicinecontinuestoevolveandindividualcircumstanceswillvary.Thisopinionre?ectsinformation available at the time of acceptance for publication and is neither designed nor intended to establish (...) %.Withmoderateventriculomegaly(13e15mm),thelikelihood of normal neurodevelopment is 75e93%. The following are Society for Maternal-Fetal Medicine recommendations: We suggest that ventriculomegaly be characterized as mild (10e12 mm), moderate (13e15 mm), or severe (>15 mm) for the purposes of patient counseling, given that the chance of an adverse outcome and potential for other abnormalities are higher when the ventricles measure 13e15 mm vs 10e12 mm (GRADE 2B); we recommend that diagnostic testing (amniocen- tesis

2019 Society for Maternal-Fetal Medicine

17. Systematic review: Clinical decision rules for the assessment of mild head injury, used in combination with clinical judgment, can inform the use of head imaging

Systematic review: Clinical decision rules for the assessment of mild head injury, used in combination with clinical judgment, can inform the use of head imaging Clinical decision rules for the assessment of mild head injury, used in combination with clinical judgment, can inform the use of head imaging | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn (...) more about how we use cookies, please see our . Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Clinical decision rules for the assessment of mild head injury, used in combination

2012 Evidence-Based Medicine (Requires free registration)

18. Can the important brain injury criteria predict neurosurgical intervention in mild traumatic brain injury? A validation study.

Can the important brain injury criteria predict neurosurgical intervention in mild traumatic brain injury? A validation study. There is variability in the management of patients presenting to the emergency department (ED) with mild traumatic brain injury (MTBI) and abnormal findings on their initial head computed tomography (CT). The main objective of this study was to validate the value of the Important Brain Injury (IBI) criteria, introduced by the Canadian CT-Head Rule, in predicting (...) the need for surgical intervention. The secondary objective was to identify independent predictors for neurosurgical intervention.This is a post hoc analysis of a prospective cohort of adult patients presenting to the ED of one tertiary care, academic center, between 2008 and 2012, with MTBI and an abnormal initial head CT. Neurosurgical intervention was at the discretion of the treating physician. The sensitivity and specificity of the IBI criteria were calculated with 95% confidence intervals (CI95

2019 EvidenceUpdates

19. Head Injury and patients on Anticoagulation/Antiplatelet Therapies

. Barbosa RR et al. 2012. Evaluation and management of mild traumatic brain injury: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg, 73;5:Sup 4. 7. Vos PE, et al. 2012. Mild traumatic brain injury. European journal of neurology 19(2): 191-198. 8. NSW Ministry of Health. 2011. Adult trauma clinical practice guidelines: Initial management of closed head injury in adults. (2nd Ed). Accessed March 2017. http://www.aci.health.nsw.gov.au/__data/assets (...) to review the evidence for managing patients who present with mild trauma to the head and are known to be on oral anticoagulant, antiplatelet therapy. Objective The objectives of this scoping review were to determine: A. How anticoagulants or antiplatelet agents should be managed for patients with minor head trauma? B. What is the optimal timing and frequency of Computed Tomography (CT) brain scans in the period following the minor head trauma (e.g. fall) to determine if intracranial bleeding has

2017 Monash Health Evidence Reviews

20. Development and Internal Validation of a Clinical Risk Score for Treating Children With Mild Head Trauma and Intracranial Injury. (PubMed)

Development and Internal Validation of a Clinical Risk Score for Treating Children With Mild Head Trauma and Intracranial Injury. The appropriate treatment of children with mild traumatic brain injury (mTBI) and intracranial injury (ICI) on computed tomographic imaging remains unclear. Evidence-based risk assessments may improve patient safety and reduce resource use.To derive a risk score predicting the need for intensive care unit observation in children with mTBI and ICI.This retrospective (...) analysis of the prospective Pediatric Emergency Care Applied Research Network (PECARN) head injury cohort study included patients enrolled in 25 North American emergency departments from 2004 to 2006. We included patients younger than 18 years with mTBI (Glasgow Coma Scale [GCS] score, 13-15) and ICI on computed tomography. The data analysis was conducted from May 2015 to October 2016.The primary outcome was the composite of neurosurgical intervention, intubation for more than 24 hours for TBI

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2017 JAMA pediatrics

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