Subject(s)
Analgesics, Opioid/therapeutic use , Emergency Service, Hospital/standards , Acute Pain/drug therapy , Adult , Analgesics, Opioid/adverse effects , Humans , Low Back Pain/drug therapy , Opioid-Related Disorders/prevention & control , Pain Management/methods , Pain Management/standards , Risk FactorsABSTRACT
This clinical policy provides evidence-based recommendations on select issues in the management of adult patients with mild traumatic brain injury (TBI) in the acute setting. It is the result of joint efforts between the American College of Emergency Physicians and the Centers for Disease Control and Prevention and was developed by a multidisciplinary panel. The critical questions addressed in this clinical policy are: (1) Which patients with mild TBI should have a noncontrast head computed tomography (CT) scan in the emergency department (ED)? (2) Is there a role for head magnetic resonance imaging over noncontrast CT in the ED evaluation of a patient with acute mild TBI? (3) In patients with mild TBI, are brain specific serum biomarkers predictive of an acute traumatic intracranial injury? (4) Can a patient with an isolated mild TBI and a normal neurologic evaluation result be safely discharged from the ED if a noncontrast head CT scan shows no evidence of intracranial injury? Inclusion criteria for application of this clinical policy's recommendations are nonpenetrating trauma to the head, presentation to the ED within 24 hours of injury, a Glasgow Coma Scale score of 14 or 15 on initial evaluation in the ED, and aged 16 years or greater. The primary outcome measure for questions 1, 2, and 3 is the presence of an acute intracranial injury on noncontrast head CT scan; the primary outcome measure for question 4 is the occurrence of neurologic deterioration.
Subject(s)
Brain Injuries/diagnosis , Diagnostic Imaging/standards , Emergency Service, Hospital/standards , Practice Guidelines as Topic , Adult , Aged , Brain Injuries/classification , Decision Making , Diagnostic Imaging/trends , Emergency Service, Hospital/trends , Emergency Treatment/standards , Evidence-Based Medicine , Female , Forecasting , Glasgow Coma Scale , Health Policy , Humans , Injury Severity Score , Magnetic Resonance Imaging/standards , Magnetic Resonance Imaging/trends , Male , Middle Aged , Policy Making , Randomized Controlled Trials as Topic , Sensitivity and Specificity , Tomography, X-Ray Computed/standards , Tomography, X-Ray Computed/trends , Total Quality Management , United States , Young AdultABSTRACT
This clinical policy provides evidence-based recommendations on select issues in the management of adult patients with mild traumatic brain injury (TBI) in the acute setting. It is the result of joint efforts between the American College of Emergency Physicians and the Centers for Disease Control and Prevention and was developed by a multidisciplinary panel. The critical questions addressed in this clinical policy are: (1) Which patients with mild TBI should have a noncontrast head computed tomography (CT) scan in the emergency department (ED)? (2) Is there a role for head magnetic resonance imaging over noncontrast CT in the ED evaluation of a patient with acute mild TBI? (3) In patients with mild TBI, are brain specific serum biomarkers predictive of an acute traumatic intracranial injury? (4) Can a patient with an isolated mild TBI and a normal neurologic evaluation result be safely discharged from the ED if a noncontrast head CT scan shows no evidence of intracranial injury? Inclusion criteria for application of this clinical policy's recommendations are nonpenetrating trauma to the head, presentation to the ED within 24 hours of injury, a Glasgow Coma Scale score of 14 or 15 on initial evaluation in the ED, and aged 16 years or greater. The primary outcome measure for questions 1, 2, and 3 is the presence of an acute intracranial injury on noncontrast head CT scan; the primary outcome measure for question 4 is the occurrence of neurologic deterioration.
Subject(s)
Brain Injuries/classification , Decision Making , Emergency Service, Hospital/standards , Guidelines as Topic , Adolescent , Adult , Aged , Brain Injuries/physiopathology , Evidence-Based Medicine , Female , Glasgow Coma Scale , Humans , Injury Severity Score , Male , Middle Aged , Registries , Young AdultABSTRACT
[American College of Emergency Physicians: Clinical policy for procedural sedation and analgesia in the emergency department. Ann Emerg Med May 1998;31:663-677.].
ABSTRACT
[American College of Emergency Physicians: Clinical policy for the initial approach to patients presenting with acute blunt trauma. Ann Emerg Med March 1998;31:422-454.].