The danger of an ultra-early computed tomographic scan in a patient with an evolving acute epidural hematoma

Smith, Harold K.; Miller, J. D.

doi:10.1097/00006123-199108000-00016

Cited by 28 publications

(16 citation statements)

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“…However, the team physician has to keep in mind, that intracerebral haemorrhage or oedema can develop within hours, for instance, an extradural haematoma within 6 hours. Thus the initial CT may be false negative when performed very early (within 1 h) (Smith & Miller, 1991;Vos et al, 2012).…”

Section: Diagnosismentioning

confidence: 99%

Return to play management after concussion in football: recommendations for team physicians

Feddermann-Demont

Straumann

Dvořák

2014

Journal of Sports Sciences

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A concussion is a rare but potentially serious injury of football players. Thus, an immediate and valid diagnosis, estimate of severity and therapeutic management is required. To summarise the published information on management of concussion with respect to a safe return to play (RTP), a literature search was conducted. Current guidelines on concussion in sports and significant studies on concussion in football were analysed. After concussion, management and RTP decision should remain in the area of clinical judgement on an individualised basis according to the current international guidelines. If a concussion is suspected, the player should not be allowed to RTP the same day. The RTP programme should follow a gradual step-wise procedure. A concussed player should not RTP unless he/she is asymptomatic and the neurological and neuropsychological examinations are normal. Untimely RTP bears an increased risk of sustaining another more severe brain injury and repetitive brain injury of long-term sequelae. In football, the management of concussion should primarily follow the recommendations proposed by the Concussion in Sports Group. Information and education of players and their medical and coaching team help to protect the players' health. Future studies on concussion should include validated and detailed information on RTP protocols. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58

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Section: Diagnosismentioning

confidence: 99%

Return to play management after concussion in football: recommendations for team physicians

Feddermann-Demont

Straumann

Dvořák

2014

Journal of Sports Sciences

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“…Patients with acute EDH may present with only minimal complaints such as headache, nausea, and vomiting (Miller et al, 1990). The clinical signs associated with EDH depend on the location and speed of growth of the hematoma and on the presence of associated intradural lesions (Poon et al, 1992;Smith et al, 1991;Marshall et al, 1983). Some patients had a transient loss of consciousness immediately after impact followed by a lucid interval, followed by a second deterioration in consciousness as the hematoma expands.…”

Section: Clinical Manifestationmentioning

confidence: 99%

Traumatic Extradural Hematoma Overview, Clinical Study and Management

Alakaishy¹,

Hejaju²,

Yaqoobi³

et al. 2017

Int.J.Curr.Res.Aca.Rev.

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Article InfoThe study was conducted at neurosurgical hospital in Baghdad depending on patient's case sheet data. The study was carried retrospectively. The patients from 1.1.2004 till 1.5.2005 were taken in consideration and we found 50 cases treated by surgical intervention and 12 cases treated conservatively. Patients with EDHs less than 0.5 cm were treated conservatively and those with postoperative EDHs of elective neurosurgical procedures in addition to incompletely filled patients' files were excluded. All patients data were recorded including the demographic characteristics and clinical parameters: side, site and size of haematoma (maximum thickness). The study concluded that conservative treatment had a role in management of EDHs.

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“…Although initial imaging should ideally occur after 6 hours of the injury in order to avoid missing lesions from ultra-early imaging, clinically significant lesions are rare and have only been published as case reports. 8 In most situations, it is appropriate to simply follow the patient's clinical exam, rather than schedule repeat imaging.…”

Section: Developing a Clinical Guidelinementioning

confidence: 99%

“…1 Case reports have illustrated the need for repeat imaging in the setting of "ultra-early" CT scans, which may not capture a developing hematoma. 2 In addition, EDHs have been reported to be more likely to enlarge if captured within 6 hours of injury 3 -again enforcing the importance of repeat imaging for these patients. At the same time, while such case reports and small case series have demonstrated the importance of imaging at least 6 hours after the initial injury, patients who have already had a negative CT scan generally do not get a repeated scan, -even if the negative scan was performed within 6 hours of their injury.…”

mentioning

confidence: 98%