Head injury: triage, assessment, investigation and early management of head injury in children, young people and adults (NICE guideline CG 176)

Davis, Tessa; Ings, Anna

doi:10.1136/archdischild-2014-306797

Cited by 108 publications

(40 citation statements)

References 7 publications

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“…A 2017 meta-analysis concluded that the NEXUS criteria are at best a guide to clinical assessment, and not a strict protocol, while evidence for the accuracy of the CCR to detect CSI in the paediatric population is lacking [14]. Nevertheless, current international guidelines recommend combining both predicting rules [11,15,16].…”

Section: Introductionmentioning

confidence: 99%

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Brinke

Slinger

Slaar³

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but currently not available. As a step in developing such a protocol, we determined the incidence of cervical spine injury and the degree of protocol adherence at our level 2 trauma centre. Methods We analysed data from all patients aged < 16 years suspected of cervical spine injury after blunt trauma who had presented to our hospital during two periods: January 2010 to June 2012, and January 2017 to June 2019. In the intervening period, the imaging protocol for diagnostic workup was updated. Outcomes were the incidence of cervical spine injury and protocol adherence in terms of the indication for imaging and the type of imaging. Results We included 170 children in the first study period and 83 in the second. One patient was diagnosed with cervical spine injury. Protocol adherence regarding the indication for imaging was > 80% in both periods. Adherence regarding the imaging type decreased over time, with 45.8% of the patients receiving a primary CT scan in the second study period versus 2.9% in the first. Conclusion Radiographic imaging is frequently performed when clearing the paediatric cervical spine, although cervical spine injury is rare. Particularly CT scan usage has wrongly been emerging over time. Stricter adherence to current protocols could limit overuse of radiographic imaging, but ultimately there is a need for an accurate rule predicting which children really are at risk of injury.

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Section: Introductionmentioning

confidence: 99%

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Brinke

Slinger

Slaar³

et al. 2020

Eur J Trauma Emerg Surg

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“…The direct effects of a head injury can be assessed using the level of consciousness according to the GCS when admitted to the ED. However, it should be remembered that disturbance of consciousness is not always a direct consequence of brain injury but may be associated with consciousness disorders due to alcohol or psychoactive substance toxicity, postictal state following epileptic seizure or prolonged arrhythmia leading to central hypoxia (2,25). Some of these factors may affect survival regardless of the injury.…”

Section: Discussionmentioning

confidence: 99%

“…Injuries are the third commonest cause of death worldwide following circulatory diseases and cancer. About half of deaths due to injuries occur as a result of head trauma (1,2). Loss of consciousness due to injury is a strong recommendation for head computer tomography (CT) scan (2).…”

Section: Introductionmentioning

confidence: 99%

“…About half of deaths due to injuries occur as a result of head trauma (1,2). Loss of consciousness due to injury is a strong recommendation for head computer tomography (CT) scan (2). However, in patients presenting to ED with both syncope and head trauma, it is often difficult to decide whether head trauma was preceded by syncope or whether transient loss of consciousness (TLOC) was due to brain injury (3).…”

Section: Introductionmentioning

confidence: 99%

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Prognosis of Syncope With Head Injury: a Tertiary Center Perspective

Furtan

Pochciał

Timler

et al. 2020

Front. Cardiovasc. Med.

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Aim: Head injury is the most common trauma occurring in syncope. We aimed to assess whether syncope as cause of head-trauma affects short-and long-term prognosis. Methods: From a database retrospective analysis of 97,014 individuals attending Emergency Department (ED), we selected data of patients with traumatic head injury including age, gender, injury mechanism, brain imaging, multiple traumas, bone fracture, intracranial bleeding, and mortality. Mean follow-up was 6.4 ± 1.8 years. Outcome data were obtained from a digital national population register. The study population included 3,470 ED head injury patients: 117 of them (50.0 ± 23.6 years, 42.7% men) reported syncope as cause of head trauma and 3,315 (32.2 ± 21.1 years, 68.5% men) without syncope preceding head trauma. Results: Thirty-day mortality was low and similar in traumatic head injury with or without syncope. One year and long-term all-cause mortality were both significantly higher in syncopal vs. non-syncopal traumatic head injury (11.1 vs. 2.8% and 32 vs. 10.2%, respectively; both p < 0.001). In adjusted logistic regression analysis, death between 121st-day and 1 year in patients with head-trauma was associated with male gender [odds ratio (OR): 6.48; 95% CI: 2.59-16.25], advancing age (per year) (OR 1.09; 95% CI 1.07-1.11), Glasgow Coma Scale < 13 (OR: 6.18; 95% CI:1.68-22.8), bone fracture (OR 4.72; 95% CI 2.13-10.5), and syncope (OR 3.70; 95% CI: 1;48-9.31). In multivariable Cox regression analysis, syncope was one of the strongest independent predictors of long-term all-cause death (hazard ratio: 1.95; 95% CI 1.37-2.78). Conclusion: In patients with head trauma, history of syncope preceding injury does not increase 30-day all-cause mortality but portends increased 1 year and long-term mortality.

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“…Concern for TBI is raised if the combatant manifests or reports symptoms of headache, blurred vision, double vision, nausea, vomiting, balance or gait issues after a bout. [10,11] 2. Any combatant with a Glasgow Coma Scale/Score (GCS) of less than 13 on initial assessment, suspected open or depressed skull fracture, suspected basal skull fracture, post-traumatic seizure, focal neurological deficit and/or greater than one episode of vomiting since the suspected head injury should be urgently transported to the designated Level I trauma centre via an on-site ambulance for a CT scan of the head (as per National Institutes of Health and Care Excellence (NICE) guidelines for determining the need for an acute CT scan of the head in adults following a traumatic head injury).…”

Section: Neuroimaging After a Boutmentioning

confidence: 99%

Neuroimaging in contact sports: Determining brain fitness before and after a bout

Sethi

2017

S. Afr. j. sports med

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Background: Professional boxing and mixed martial arts (MMA) are popular contact sports with high risk for both acute and chronic traumatic brain injury (TBI). Although rare, combatants have died in the ring/cage or soon after the completion of the bout. The cause of death in these cases is usually acute subdural hematoma, acute epidural hematoma, subarachnoid haemorrhage, intracranial haemorrhage, or second-impact syndrome (SIS). Neuroimaging or brain imaging is currently included in the process of registering for a license to fight in a combat sport in most states in the United States and around the world. However, the required imaging specifics and frequency vary.Discussion: Neuroimaging serves two distinct roles in the individualised care of a combatant, representing a step towards personalised medicine and individual risk stratification. Neuroimaging prior to licensure helps to identify and/or exclude coincidental or clinically suspected brain lesions which may pose a risk for rupture, bleeding or other catastrophic and important brain injury. Neuroimaging in the immediate aftermath of a bout primarily serves to rule out acute traumatic brain injury. Neuroimaging may also be carried out to assess for evidence of structural brain injury which may make a combatant more likely to express late-life neuropsychiatric sequelae of brain injury, such as chronic traumatic encephalopathy. As such, neuroimaging plays a prognostic role and aids in the determination of whether the combatant should be allowed to continue to participate in future bouts or not.Conclusion: Currently there are no established neuroimaging guidelines for contact sports. Standardising neuroimaging guidelines both for licensure as well as neuroimaging modality, and protocols to assess for both acute and chronic traumatic brain injury. This will assist in protecting the combatant’s health and safety, both in the ring/cage, and after their professional careers have ended. Some suggested guidelines are provided based on currently available medical literature. It is recommended that these guidelines be debated vigorously by the scientific community and that evidence-based guidelines be developed by the medical community in conjunction with professional boxing and MMA governing bodies.

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Head injury: triage, assessment, investigation and early management of head injury in children, young people and adults (NICE guideline CG 176)

Cited by 108 publications

References 7 publications

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

Prognosis of Syncope With Head Injury: a Tertiary Center Perspective

Neuroimaging in contact sports: Determining brain fitness before and after a bout

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