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Discharge Considerations After Minor Head Injuries

Discharge Considerations After Minor Head Injuries

In elderly patients suffering a fall, long-term anticoagulation has been shown to increase the incidence of intracranial hemorrhage (ICH) and mortality. Patients who receive treatment with anticoagulants have a higher risk for bleeding and can sometimes have serious outcomes after experiencing even relatively minor head injuries. Given the increasing number of elderly patients seen in EDs and the increase in concomitant anticoagulant use, the clinical dilemmas surrounding these patients have become more relevant. Several clinical decision rules have been created to help determine which head injury patients require a head CT scan, but these rules do not apply to anticoagulated patients. “There is some controversy surrounding the utility of head CT in allowing safe discharge dispositions for anticoagulated patients who suffer minor head injuries,” says Samuel M. Keim, MD, MS. Questions remain about whether or not a period of observation or routine serial CT scanning is warranted for these patients. A Closer Look In the Journal of Emergency Medicine, Dr. Keim and colleagues published a critical appraisal study that examined the risks of delayed ICH in anticoagulated patients with minor head injury and a normal initial head CT scan. The researchers reviewed four observational studies that investigated the outcomes of anticoagulated patients who presented to EDs after minor head injuries. In these observational studies, most patients who had a delayed ICH required no neurosurgical intervention and had no adverse outcome documented. The overall incidence of death or neurosurgical intervention ranged from 0% to 1.1% among the patients investigated. However, the studies did not clarify which patients were at highest risk. “Overall, the literature varied greatly but doesn’t support the...

Caring for Mild Traumatic Brain Injuries

The CDC estimates that about1.5 million traumatic brain injuries (TBIs) occur each year in the United States, making these injuries a leading cause of disability. The cost of TBIs has been estimated to be approximately $60 billion per year. About 52,000 deaths are attributed to TBIs annually. Roughly 80% of patients who experience a TBI have a mild TBI, or concussion, caused by a bump or blow to the head. The American Association of Neuroscience Nurses (AANN) has existing guidelines for the care of patients with moderate or severe TBI, but until now, there have not been evidence-based, clinical guidelines for the care of patients with mild TBI. The AANN has teamed up with the Association of Rehabilitation Nurses (ARN) to create a clinical guideline called “Care of the Patient With Mild Traumatic Brain Injury,” which was released in 2011. The guidelines— available for free at www.rehabnurse.org and www.aann.org—are meant to help registered nurses, advanced practice nurses, and institutions provide safe and effective care to injured patients with a mild TBI. “Follow-up care is critical for patients with mild TBI, along with patient education.” “Recently, there has been a strong focus on TBIs among high school, college, and professional athletes, with new research showing the residual effects that remain in some patients with mild TBI,” says Therese West, RN, CPN, MSN, APN-C, lead author of the AANN/ARN guidelines. “Previously, it was thought that when patients received a blow to the head, they would get a little lump and maybe a headache, but they would ultimately be fine. The literature, however, is now showing that this is not necessarily the case. Most...

Conference Highlights: Society of Critical Care Medicine 2011

The SCCM annual congress addressed important issues in the management of critically ill and injured patients, including CNS disorders in pediatric patients, early metabolic crisis after TBI, and inappropriate prescribing in the elderly after ICU discharge. » Characterizing Pediatric CNS Hospitalizations » Early Metabolic Crisis Common After TBI » The Elderly Receive Unnecessary Prescriptions After ICU Discharge Characterizing Pediatric CNS Hospitalizations The Particulars: Children with acute disorders of the central nervous system (CNS) are at risk of substantial morbidity and mortality. Previous research has found that 65% of deaths in children who die in the ICU were associated with acute CNS injuries. Among children who were previously healthy and later died, 96% of deaths have been associated with CNS injuries. Data Breakdown: A retrospective study sought to determine the volume and outcomes of hospitalized children with acute CNS disorders. After assessing 960,000 admissions for children aged 29 days to 19 years, non-traumatic disorders accounted for 79.7% of the admissions. The most common specific disorders were seizures (60.1%) and mild traumatic brain injury (19.2%). Children with acute CNS disorders received intensive care almost three times as often, were mechanically ventilated almost seven times as often, and died more than eight times as often as other hospitalized children. Take Home Pearls: Children with acute CNS disorders appear to be seen in hospital ICUs more often and have higher in-hospital mortality than children seen for other reasons. Early Metabolic Crisis Common After TBI [back to top] The Particulars: Previous research has suggested that metabolic crisis occurs frequently after traumatic brain injury (TBI). Little is known about the efficacy of standard resuscitation protocols for resolving these crises. Data...

Conference Highlight: Society of Critical Care Medicine

New research presented at the 40th annual congress of the Society of Critical Care Medicine from January 15-19, 2011 in San Diego addressed important issues in the management of critically ill and injured patients. The features below highlight just some of the studies that emerged from the congress. Characterizing Pediatric CNS Hospitalizations Early Metabolic Crisis Common After TBI The Elderly Receive Unnecessary Prescriptions After ICU Discharge  Characterizing Pediatric CNS Hospitalizations The Particulars: Children with acute disorders of the central nervous system (CNS) are at risk of substantial morbidity and mortality. Previous research has found that 65% of deaths in children who die in the ICU were associated with acute CNS injuries. Among children who were previously healthy and later died, 96% of deaths have been associated with CNS injuries. Data Breakdown: A retrospective study sought to determine the volume and outcomes of hospitalized children with acute CNS disorders. After assessing 960,000 admissions for children aged 29 days to 19 years, non-traumatic disorders accounted for 79.7% of the admissions. The most common specific disorders were seizures (60.1%) and mild traumatic brain injury (19.2%). Children with acute CNS disorders received intensive care almost three times as often, were mechanically ventilated almost seven times as often, and died more than eight times as often as other hospitalized children. Take Home Pearls: Children with acute CNS disorders appear to be seen in hospital ICUs more often and have higher in-hospital mortality than children seen for other reasons. Early Metabolic Crisis Common After TBI [back to top] The Particulars: Previous research has suggested that metabolic crisis occurs frequently after traumatic brain injury (TBI). Little...
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