EFNS guideline on mild traumatic brain injury: report of an EFNS task force

Vos, Pieter E.; Battistin, Leontino; Birbamer, G.; Gerstenbrand, F; Потапов, А. А.; Prevec, Tine S.; Stepan, C; Traubner, P; Twijnstra, A.; Vécsei, László; Wild, K. von

doi:10.1046/j.1468-1331.2002.00407.x

Cited by 282 publications

(239 citation statements)

References 118 publications

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“…According to our hospital protocol, a neurologist and/or neurosurgeon is consulted at the ED in case a head trauma patient presents with i) a Glasgow Coma Scale (GCS) of 3-14, or ii) a GCS of 15 with loss of consciousness (LOC) and/or posttraumatic amnesia (PTA), or iii) a GCS of 15 without LOC and PTA, but fulfilling additional criteria: unclear or ambiguous accident history, persisting or progressive headache, nausea and vomiting, intoxication with alcohol or drugs, epileptic seizures, coagulation disorders, platelet aggregation inhibitors or oral anticoagulation use, confusion, disorientation, feeling dazed, retrograde amnesia, focal neurological deficits, age O60 or !2 years, high-energy accident, or visible trauma above the clavicles (including signs of skull (base) fracture) (23). According to the hospital admission GCS, TBI patients are classified as mild (GCS 13-15), moderate (Mod) (GCS 9-12), or severe (GCS %8) (23,24). In RUBICS, we register various clinical variables obtained from the ambulance or helicopter trauma physician, the ED, the intensive care unit (ICU), and the neurological and neurosurgical ward.…”

Section: Methodsmentioning

confidence: 99%

Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

Eerden¹,

Twickler

Sweep³

et al. 2010

European Journal of Endocrinology

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Context: A wide range (15-56%) of prevalences of anterior pituitary insufficiency are reported in patients after traumatic brain injury (TBI). However, different study populations, study designs, and diagnostic procedures were used. No data are available on emergency-department-based cohorts of TBI patients. Objective: To assess the prevalence of pituitary dysfunction in an emergency-department-based cohort of TBI patients using strict endocrinological diagnostic criteria. Methods: Of all the patients presenting in the emergency department with TBI over a 2-year period, 516 matched the inclusion criteria. One hundred and seven patients (77 with mild TBI and 30 with moderate/severe TBI) agreed to participate. They were screened for anterior pituitary insufficiency by GHRH-arginine testing, evaluation of fasting morning hormone levels (cortisol, TSH, free thyroxine, FSH, LH, and 17b-estradiol or testosterone), and menstrual history 3-30 months after TBI. Abnormal screening results were defined as low peak GH to GHRH-arginine, or low levels of any of the end-organ hormones with low or normal pituitary hormone levels. Patients with abnormal screening results were extensively evaluated, including additional hormone provocation tests (insulin tolerance test, ACTH stimulation test, and repeated GHRH-arginine test) and assessment of free testosterone levels. Results: Screening results were abnormal in 15 of 107 patients. In a subsequent extensive endocrine evaluation, anterior pituitary dysfunction was diagnosed in only one patient (partial hypocortisolism). Conclusion: By applying strict diagnostic criteria to an emergency-department-based cohort of TBI patients, it was shown that anterior pituitary dysfunction is rare (!1%). Routine pituitary screening in unselected patients after TBI is unlikely to be cost-effective.

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Section: Methodsmentioning

confidence: 99%

Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

Eerden¹,

Twickler

Sweep³

et al. 2010

European Journal of Endocrinology

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“…5,10,29,32,34) Mechanisms of injury as indications for CT include pedestrian struck by motor vehicle or occupant ejected from motor vehicle, falling from height À3 feet or five stairs, 29) involvement in a high-energy accident, and unclear or ambiguous mechanisms. 34) Our study also revealed that patients falling from stairs or height and pedestrians in motor vehicle accidents were likely to have intracranial injury. Patients sustaining fall, assault, or crush injury are at risk of intracranial injury compared with patients involved in motor vehicle crashes.…”

Section: Ct Indications In Mild Head Injurymentioning

confidence: 99%

“…Therefore, CT should be the first choice in patients with suspected intracranial lesion. 28) The indication for skull radiography is limited to patients with GCS score 15 and only LOC/amnesia, 34) one other symptom, 5,24,32,34) or symptoms without vomiting, but only if CT is recommended but not available. 25) Many studies have reported increased risk of intracranial lesions in patients with head injury aged over 65 years 9,29) or over 60 years.…”

Section: Ct Indications In Mild Head Injurymentioning

confidence: 99%

“…23) Guidelines for such mild head injury are common in other countries, and all such classifications are based on the GCS, because GCS on admission is strongly related to intracranial injury. These guidelines are in wide agreement regarding two points: patients with clear consciousness without symptoms or risk factors can be discharged with an information sheet 5,10,12,17,23,24,32,34) ; and patients with GCS score of less than 15 should undergo computed tomography (CT) regardless of the presence of symptoms or risk factors. 5,10,13,23,24,29,32,34) However, clinicians are divided regarding which clinical features and risk factors warrant CT in patients with GCS score of 15.…”

Section: Introductionmentioning

confidence: 99%

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Indications for Computed Tomography in Patients With Mild Head Injury

Ono

Wada

Takahara

et al. 2007

Neurol. Med. Chir.(Tokyo)

137

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The factors affecting outcome were analyzed in 1,064 patients, 621 males and 443 females aged 10 to 104 years (mean 46 ± 23 years), with mild head injury (Glasgow Coma Scale [GCS] score AE14) but no neurological signs presenting within 6 hours after injury. Intracranial lesion was found in 4.7% (50/1,064), and 0.66% (7/1,064) required surgical treatment. The Japan Coma Scale (JCS) and GCS assessments were well correlated (r ＝ 0.797). Multivariate analysis revealed significant correlations between computed tomography (CT) abnormality and age AE60 years, male sex, JCS score AE1, alcohol consumption, headache, nausea/vomiting, and transient loss of consciousness (LOC)/amnesia. Univariate analysis revealed that pedestrian in a motor vehicle accident, falling from height, and mechanisms of injuries except blows were correlated to intracranial injury. No significant correlations were found between craniofacial soft tissue injury and intracranial injury. Patients with occipital impact, nonfrontal impact, or skull fracture were more likely have intracranial lesions. Bleeding tendency was not correlated with CT abnormality. The following indications were proposed for CT: JCS score À0, presence of accessory symptoms (headache, nausea/vomiting, LOC/amnesia), and age AE60 years. These criteria would reduce the frequency of CT by 29% (309/1,064). Applying these indications to subsequent patients with GCS scores 14-15, 114 of 168 patients required CT, and intracranial lesions were found in 13. Two refused CT. Fifty-four of the 168 patients did not need CT according to the indications, but 38 of the 54 patients actually underwent CT because of social reasons (n ＝ 21) or patient request (n ＝ 17). These indications for CT including JCS may be useful in the management of patients with mild head injury.

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“…As stated in current guidelines discussing head injury and warfarin use, liberal CT scanning of the head seems to be a reasonable strategy, even for those who present with normal mental status and a GCS score of 15. [10][11][12][13] The risk of delayed bleeding appears to be very close to zero with clopidogrel, suggesting that routine hospitalization and follow-up scanning might not be necessary. Patients taking warfarin are not without risk and probably do require follow-up but not necessarily routine (second) CT.…”

Section: Resultsmentioning

confidence: 99%

Traumatic intracranial hemorrhage in patients using warfarin or clopidogrel

Alsakha

Guttman

2014

CJEM

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Clinical questionWhat is the prevalence of immediate and incidence of delayed intracranial hemorrhage in patients with blunt head trauma who use warfarin or clopidogrel? Article chosen Nishijima DK, Offerman SR, Ballard DW, et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Ann Emerg Med 2012;59:460-8.e7. Study objectiveTo assess the prevalence of immediate and the cumulative incidence of delayed traumatic intracranial hemorrhage in patients using warfarin or clopidogrel.

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EFNS guideline on mild traumatic brain injury: report of an EFNS task force

Cited by 282 publications

References 118 publications

Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

Indications for Computed Tomography in Patients With Mild Head Injury

Traumatic intracranial hemorrhage in patients using warfarin or clopidogrel

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