Management of head injuries in children.

Head injury is the most common cause of injury-related death and permanent disability in children. Minor head trauma is common in childhood and does not require any medical treatment. Although deficits can occur even after mild to moderate head injury, they are markedly greater and become clinically evident following severe head injury. It is important that emergency department clinicians are aware of the signs and symptoms that indicate severe traumatic brain injury and triage for urgent intervention in those children who present with these signs and symptoms. Clinicians also need to know when children can be sent home with reassurance and information, and when they require admission or transfer to a neurosurgical unit. This article examines the literature on head injuries in children, describes assessment, management and treatment, and provides a simple management algorithm.

An Observational Study of 2,248 Patients Presenting With Headache, Suggestive of Subarachnoid Hemorrhage, Who Received Lumbar Punctures Following Normal Computed Tomography of the Head.

OBJECTIVES: The objective was to determine the incidence of subarachnoid hemorrhage (SAH) diagnosed by lumbar puncture (LP) when the head computed tomography (CT) was reported as demonstrating no subarachnoid blood. METHODS: Data were obtained on patients who received LP to diagnose or exclude SAH attending six hospitals over 5 years. Subsequent investigations and outcomes were reviewed in all patients with LPs that did not exclude SAH. RESULTS: A total of 2,248 patients were included. A total of 1,898 LPs were suitable for biochemical analysis, of which 92 (4.8%) were positive for blood, suggesting SAH; 1,507 (79.4%) were negative; and 299 (15.6%) were inconclusive. Of the 92 patients with positive cerebrospinal fluid analysis, eight patients (0.4%) had aneurysms on further imaging, and one had a carotid cavernous fistula. CONCLUSIONS: In patients presenting to the emergency department with acute severe headache, LP to diagnose or exclude SAH after negative head CT has a very low diagnostic yield, due to low prevalence of the disease and uninterpretable or inconclusive samples. A clinical decision rule may improve diagnostic yield by selecting patients requiring further evaluation with LP following nondiagnostic or normal noncontrast CT brain imaging.

Emergency department multiprofessional handover.

BACKGROUND: Emergency department (ED) handovers are arguably more complex than handovers in the ward environment. This is because of an unpredictable patient load, fluctuations in acuity, compressed time frames and the undifferentiated or undiagnosed nature of clinical problems. In order to ensure safe, relevant and accurate handovers, we have implemented a novel multiprofessional model. The model ensures that staff groups communicate, interact and learn together. In this study we investigated the effectiveness and usefulness of this new morning handover structure at St Thomas' Hospital, a busy teaching hospital in London, UK. METHODS: A questionnaire about the multiprofessional handover (MPH) was given to all 75 staff attending an MPH over a 1-week period, a year after it was introduced. The objective was to determine whether MPH is effective in the Emergency Department. RESULTS: All 75 staff attending MPH in the study period completed a questionnaire. All of the staff found it a useful update on departmental and trust-wide issues. The results demonstrated that staff mostly supported the new MPH structure. A majority agreed that it provided enough information about patient care (67 staff members). The results suggested that MPH is an effective way to deliver handover within the ED. DISCUSSION: Our unique morning handover structure ensures patient safety, as well as the appropriate transfer of information and responsibility to all involved with the care of patients in the ED. It offers the opportunity for multiprofessional learning, encourages teamwork and improves operational processes within the ED.