FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2021903596> ?p ?o ?g. }

• W2021903596 endingPage "456" @default.
• W2021903596 startingPage "455" @default.
• W2021903596 abstract "In the United Kingdom some 500 000 children attend accident and emergency departments after a head injury and about 50 000 are admitted (nearly 10% of all hospital admissions). The death rate is 5.3 per 100 000 children.1 Despite various guidelines on the management of head injury, clinical practice varies. Two papers in this week's BMJ shed new light on the management of mild head injury in children admitted to emergency departments.2,3 They compare immediate computed tomography for triage with inpatient observation in mild head injury—920 of the 2602 enrolled patients were aged 6-15. No child died or needed surgical intervention. Early discharge after immediate computed tomography was no worse in terms of recovery at three months, later complications, and patient satisfaction; it was also less costly than inpatient observation.Here is a scenario familiar to emergency department doctors, paediatricians, and general practitioners. A child suffers apparently mild head trauma with brief loss of consciousness. When seen, he or she has normal neurological findings and a Glasgow coma scale score of 15. The child makes an uninterrupted recovery but spends 24 hours in hospital, with worried parents at the bedside and nurses performing hourly neurological observations of variable quality. Fortunately a less common scenario is that, in the hour or so between the decision to admit the child and actual admission to the ward, he or she develops neurological signs from an unsuspected subdural haematoma and is left with permanent sequelae, despite transfer to a neurosurgical centre. How then, do we differentiate between children who need urgent imaging and referral to a neurosurgical service and those who need observation only?A literature review designed to inform a clinical practice guideline for the American Academy of Pediatrics found 108 relevant studies before 1999, but it concluded that there was not sufficient scientific basis for evidence based recommendations on key management issues.4 A subsequent meta-analysis of studies investigating clinical variables that might predict serious intracranial injury in children showed, unsurprisingly, that predictors include reduced level of consciousness, focal neurological signs, and skull fracture. Neither headache (difficult or impossible to recognise in children who have not yet started to speak) nor vomiting increased the risk.5Skull radiography was used for many decades to identify children at greatest risk. However, although skull fractures increase the risk of intracranial injury fourfold, the presence of a fracture is of limited value as a diagnostic test—with a calculated sensitivity of 59% and specificity of 88%.5 A retrospective audit of two cohorts of children presenting to an emergency department in a UK paediatric teaching hospital (before and after restricting the use of skull x rays) concluded that abolishing the use of x rays, except in infants under 12 months, did not increase the admission rate or the rate of missed intracranial injury and reduced overall radiation dosage, despite doubling the proportion of children who receive a computed tomography scan from 1.0% to 2.1%.6 The authors' protocol permitted skull x rays for the youngest infants if non-accidental injury was suspected or evidence of head trauma existed.7In June 2003, the National Institute for Clinical Excellence (NICE) published clinical guidelines for managing head injury; these guidelines were mainly based on the Canadian computed tomography head rule and the New Orleans criteria.8,9 Both these sets of criteria are 100% sensitive for the need for neurosurgical intervention, and the Canadian rules have higher specificity for important clinical outcomes (50.6% v 12.7%) so are likely to result in lower imaging rates.10These guidelines advocate a strategy based on early computed tomography scanning for patients deemed clinically to be at high risk and a major reduction in the use of skull x rays. Audits in the UK, conducted since the guidelines were adopted, have shown an increase in the incidence of performing computed tomography head scans: from 1-2% to 7-9% of attendees of all ages in hospitals following NICE guidelines11,12 and from 14% to 20% at a hospital following the Canadian rules.13The practicability of applying any of these guidelines will depend to some extent on the availability of staff and imaging facilities and the cash to pay for them in a clinical situation more commonly met out of hours. One question that arises is whether extra expenditure on scanning might be balanced by savings on hospital admission—unlikely in circumstances where even patients with a normal scan might still be admitted.Clinicians may have little difficulty in predicting the response of their radiological colleagues to a request to image all patients presenting with minor head injury, however much they point out the savings of about €200 (£135; $256) per patient calculated by the Swedish group.3 To convince radiologists, further studies are needed to define a highest risk group who could be scanned on arrival then discharged (or x rayed if under 12 months) and a lowest risk group who could be sent home from an observation unit without being scanned. Two subjective issues would need to be dealt with by qualitative research: the degree to which patients are reassured by (unnecessary) imaging thereby preventing re-attendance, and the degree to which doctors' (possibly irrational) fears of medicolegal consequences of not imaging can be assuaged." @default.
• W2021903596 created "2016-06-24" @default.
• W2021903596 creator A5044306463 @default.
• W2021903596 date "2006-08-31" @default.
• W2021903596 modified "2023-09-25" @default.
• W2021903596 title "Managing minor head injury in children" @default.
• W2021903596 cites W2018411689 @default.
• W2021903596 cites W2024094443 @default.
• W2021903596 cites W2036230521 @default.
• W2021903596 cites W2044499611 @default.
• W2021903596 cites W2109222553 @default.
• W2021903596 cites W2124381692 @default.
• W2021903596 cites W2130598332 @default.
• W2021903596 cites W2139186101 @default.
• W2021903596 cites W2147394388 @default.
• W2021903596 cites W2154080521 @default.
• W2021903596 cites W2159174615 @default.
• W2021903596 cites W2171862886 @default.
• W2021903596 doi "https://doi.org/10.1136/bmj.38954.516933.de" @default.
• W2021903596 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/1557931" @default.
• W2021903596 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/16946318" @default.
• W2021903596 hasPublicationYear "2006" @default.
• W2021903596 type Work @default.
• W2021903596 sameAs 2021903596 @default.
• W2021903596 citedByCount "4" @default.
• W2021903596 crossrefType "journal-article" @default.
• W2021903596 hasAuthorship W2021903596A5044306463 @default.
• W2021903596 hasBestOaLocation W20219035962 @default.
• W2021903596 hasConcept C136764020 @default.
• W2021903596 hasConcept C142362112 @default.
• W2021903596 hasConcept C151730666 @default.
• W2021903596 hasConcept C15708023 @default.
• W2021903596 hasConcept C23123220 @default.
• W2021903596 hasConcept C2522767166 @default.
• W2021903596 hasConcept C2779760435 @default.
• W2021903596 hasConcept C2780312720 @default.
• W2021903596 hasConcept C41008148 @default.
• W2021903596 hasConcept C71924100 @default.
• W2021903596 hasConcept C86803240 @default.
• W2021903596 hasConceptScore W2021903596C136764020 @default.
• W2021903596 hasConceptScore W2021903596C142362112 @default.
• W2021903596 hasConceptScore W2021903596C151730666 @default.
• W2021903596 hasConceptScore W2021903596C15708023 @default.
• W2021903596 hasConceptScore W2021903596C23123220 @default.
• W2021903596 hasConceptScore W2021903596C2522767166 @default.
• W2021903596 hasConceptScore W2021903596C2779760435 @default.
• W2021903596 hasConceptScore W2021903596C2780312720 @default.
• W2021903596 hasConceptScore W2021903596C41008148 @default.
• W2021903596 hasConceptScore W2021903596C71924100 @default.
• W2021903596 hasConceptScore W2021903596C86803240 @default.
• W2021903596 hasIssue "7566" @default.
• W2021903596 hasLocation W20219035961 @default.
• W2021903596 hasLocation W20219035962 @default.
• W2021903596 hasLocation W20219035963 @default.
• W2021903596 hasLocation W20219035964 @default.
• W2021903596 hasOpenAccess W2021903596 @default.
• W2021903596 hasPrimaryLocation W20219035961 @default.
• W2021903596 hasRelatedWork W2086064646 @default.
• W2021903596 hasRelatedWork W2115485936 @default.
• W2021903596 hasRelatedWork W2119135658 @default.
• W2021903596 hasRelatedWork W2119214692 @default.
• W2021903596 hasRelatedWork W2357241418 @default.
• W2021903596 hasRelatedWork W2366644548 @default.
• W2021903596 hasRelatedWork W2376314740 @default.
• W2021903596 hasRelatedWork W2384888906 @default.
• W2021903596 hasRelatedWork W2748952813 @default.
• W2021903596 hasRelatedWork W2899084033 @default.
• W2021903596 hasVolume "333" @default.
• W2021903596 isParatext "false" @default.
• W2021903596 isRetracted "false" @default.
• W2021903596 magId "2021903596" @default.
• W2021903596 workType "article" @default.