ABSTRACT
OBJECTIVE: To investigate the risk factors that can be proper indications for performing brain computerized tomography (CT)-scan in patients with mild and moderate traumatic brain injury (TBI) in order to avoid unnecessary exposure to radiation, saving on costs as well as time wasted in emergency wards. METHODS: Data of patients with mild traumatic brain injury (TBI) referring to Emergency Department with age ≥2 years and primary GCS of 13-15 were examined including focal neurological deficit, anisocoria, skull fracture, multiple trauma, superior injury of clavicle, decreased consciousness, and amnesia. Brain CT-scan was performed in all the patients. Kappa Coefficient was used to determine the ratio of agreement of the CT indications (+ and â¼) and multiple logistic regression to determine the relative odds of positive CTs. RESULTS: Overall we included 610 patients. One-hundred and one patients (16.5%) had positive and 509 (83.5%) had negative CT findings. Of positive CTs, the highest percentage was dedicated to high-energy mechanism of trauma. High-energy trauma mechanism (OR=1.056, 95% CI, OR, 1.03-1.04, P<0.001), superior injury of clavicle (OR=1.07, 95% CI, OR, 1.03-1.1, P<0.001) and moderate to severe headache (OR=1.04, 95% CI, OR, 1.02-1.05, P<0.001) were positive predictors of CT findings. The combined mean of positive symptoms equaled 0.29 ± 0.64 in negative CTs, but 5.13 ± 2.4 in positive CTs, showing a significant difference. (P<0.001). CONCLUSION: Abnormal positive brain CT in victims with mild TBI is predictable if one or several risk factors are taken into account such as moderate to severe headache, decreased consciousness, skull fracture, high-energy trauma mechanism, superior injury of clavicle and GCS of 13-14. The more the symptoms, the more likely the positive CT results would be.
ABSTRACT
INTRODUCTION: Stroke is recognized as the third cause of mortality after cardiovascular and cancer diseases, so that lead to death of about 5 million people, annually. There are several scales to early prediction of at risk patients and decreasing the rate of mortality by transferring them to the stroke center. In the present study, the accuracy of Cincinnati pre-hospital stroke scale was assessed. METHODS: This was a retrospective cross-sectional study done to assess accuracy of Cincinnati scale in prediction of stroke probability in patients referred to the emergency department of Poursina Hospital, Rasht, Iran, 2013 with neurologic symptoms. Three criteria of Cincinnati scale including facial droop, dysarthria, and upper extremity weakness as well as the final diagnosis of patients were gathered. Sensitivity, specificity, predictive values, and likelihood ratios of Cincinnati scale were calculated using SPSS version 20. RESULTS: 448 patients were assessed. The agreement rate of Cincinnati scale and final diagnosis was 0.483 ± 0.055 (p<0.0001). The sensitivity of 93.19% (95% Cl: 90.11-95.54), specificity of 51.85% (95% Cl: 40.47-63.10), positive predictive value of 89.76% (95% Cl: 86.27-92.62), negative predictive value of 62.69% (95% Cl: 55.52-72.45), positive likelihood ratio of 1.94% (95% Cl: 1.54-2.43), and negative likelihood ratio of 0.13% (95% Cl: 0.09-0.20) were calculated. CONCLUSION: It seems that pre-hospital Cincinnati scale can be an appropriate screening tool in prediction of stroke in patients with acute neurologic syndromes.
ABSTRACT
Colloid cysts are mucous-filled masses with an outer fibrous layer. These cysts are rare developmental malformation and not a true neoplasm. They usually found incidentally and are asymptomatic; but in some cases may associate with rapid neurologic deterioration, herniation, and sudden death. Recognition of this rare but important diagnosis may result in decreasing mortality. In this report, we presented a 13-year-old boy with complaint of two times drop attack and final diagnosis of colloid cyst in the third brain ventricle.
