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Martin - We are talking about children with minor head injury, who have
a GCS of 15 and who are asymptomatic/minimally symptomatic in the ED.
What percentage of these children ever deteriorate in the first few
hours?  I believe that the risk of this sub-group having a neurosurgical
problem is < 10:1,000 and I suspect that none of these neurosurgical
cases are that critical that they require ultra-expeditious surgery. If
the child becomes more symptomatic (or develops an altered LOC) in the
ED while waiting for the CT scan => an expeditious scan could be
performed. I actually suspect that delaying the CT scan for a few hours
(2 - 3 hours) may actually increase the sensitivity of the CT scan for
significant intra-cranial pathology and increase the CT scan yield!
 
Also, can you quote any studies that demonstrate that observing a minor
head injury child (who is asymptomatic and who has a GCS of 15) in
hospital has any benefit when the CT scan is negative? What percentage
of those admitted children (or children who are seen in the office the
next day) ever have a neurosurgical problem?
 
Jeff.
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Date:    Thu, 19 Aug 1999 07:23:54 -0500
From:    Martin I Herman <[log in to unmask]>
Subject: Re: Timimg of CT scan of the head in children with minor head
trauma
 
I think we would scan when the patient presents with tihs scenario. Then
admit
for observation or have patient return for repeat exam ( might got to
PMD
office) Then if still symptomatic a repeat scan could be performed.
 
If one waits to let a small bleed percolate, how could you know when to
scan?
If you wait, what about the kid whoose bleed is already detectable, is
it safe
to let them sit around for hours? If the scan is delayed and negative,
then
what do you do?
 
MIH
Memphis
 
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Martin - We are talking about children with minor head injury, who have
a GCS of 15 and who are asymptomatic/minimally symptomatic in the ED. What
percentage of these children ever deteriorate in the first few hours?&nbsp;
I believe that the risk of this sub-group having a neurosurgical problem
is &lt; 10:1,000 and I suspect that none of these neurosurgical cases are
that critical that they require ultra-expeditious surgery. If the child
becomes more symptomatic (or develops an altered LOC) in the ED while waiting
for the CT scan => an expeditious scan could be performed. I actually suspect
that delaying the CT scan for a few hours (2 - 3 hours) may actually increase
the sensitivity of the CT scan for significant intra-cranial pathology
and increase the CT scan yield!
<p>Also, can you quote any studies that demonstrate that observing a minor
head injury child (who is asymptomatic and who has a GCS of 15) in hospital
has any benefit when the CT scan is negative? What percentage of those
admitted children (or children who are seen in the office the next day)
ever have a neurosurgical problem?
<p>Jeff.
<br><i>----------------------------------------------------------------------</i><i></i>
<p><i>Date:&nbsp;&nbsp;&nbsp; Thu, 19 Aug 1999 07:23:54 -0500</i>
<br><i>From:&nbsp;&nbsp;&nbsp; Martin I Herman &lt;[log in to unmask]></i>
<br><i>Subject: Re: Timimg of CT scan of the head in children with minor
head trauma</i><i></i>
<p><i>I think we would scan when the patient presents with tihs scenario.
Then admit</i>
<br><i>for observation or have patient return for repeat exam ( might got
to PMD</i>
<br><i>office) Then if still symptomatic a repeat scan could be performed.</i><i></i>
<p><i>If one waits to let a small bleed percolate, how could you know when
to scan?</i>
<br><i>If you wait, what about the kid whoose bleed is already detectable,
is it safe</i>
<br><i>to let them sit around for hours? If the scan is delayed and negative,
then</i>
<br><i>what do you do?</i><i></i>
<p><i>MIH</i>
<br><i>Memphis</i><i></i>
<p><i>------------------------------</i>
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