Journal Club
July Journal Club

July 29 (Thursday)
6:30 PM
5510 Cramblet Hall Conference Room

Journal Club Vignette

During a recent busy shift in the ED, paramedics bring in a 22 year old male who was involved in an altercation. The patient states he was assaulted by two unknown assailants, was hit in the head "a few times" and was knocked unconscious "briefly". He remembers the majority of the events and at this time is complaining of a mild headache as well as nausea. He has not vomited. He denies any alcohol or drug use in the last 24 hours. He has no other medical problems and uses no medications. On his exam, his vitals are stable, he has some mild edema and ecchymosis to his left periorbital region with superficial abrasions to his forehead and scalp. He has no C Spine or Back tenderness. His neurological exam is unremarkable and intact. He has a family member with him who will be taking him home. He looks well, but you are concerned with the LOC and are unsure if he requires a Head CT or not.

To investigate this, the following approach is explored:

PICO Question

Population: Adults with mild traumatic head injury
Intervention: Non-Contrast Head CT
Comparison: No CT
Outcome: Death, Neurosurgical Intervention


Search Strategy: Pubmed; Keywords: traumatic brain injury AND head computed tomography. Limits: English, adult, last 5 years
First years: Predicting Intracranial Traumatic Findings on Computed Tomography in Patients with Minor Head Injury: The CHIP Prediction Rule" Smits, et al. (Pub Med Link) Annals of Internal Medicine 2007

Article Critique
Second years: Developing a Decision Instrument to Guide Computed Tomographic Imaging of Blunt Head Injury Patients" Mower, et al. (Pub Med Link) Journal of Trauma 2005

Article Critique
Third years: Comparison of the Canadian CT Head Rule and the New Orleans Criteria in Patients With Minor Head Injury" Stiell et al. (Pub Med Link) JAMA 2005

Article Critique
1st, 2nd and 3rd years use the "Clinical Decision Rule Critical Review Form" (Download)


Extra Articles: Clinical Policy: Neuroimaging and Decision-making in Adult Mild Traumatic Brain Injury in the Acute Setting" Jagoda et al. Ann Emerg Med 2008

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