Core Journal Reviews

Filed Under: Tags: , , December 5th, 2019 Leave a Comment

Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial.

Recommendations that “rest is best” for concussions are based on animal research and consensus opinion. Recent evidence suggests that strict limitation of activity may not be beneficial. A small clinical trial (n=88) of pediatric patients with acute concussion randomized patients to “strict rest” for 5 days and “usual care” defined as 1-2 days of rest and then a gradual return to activities.
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Filed Under: Tags: , November 22nd, 2019 Leave a Comment

Effects of Tranexamic Acid on Death, Disability, Vascular Occlusive Events and Other Morbidities in Patients with Acute Traumatic Brain Injury (CRASH-3): A Randomised, Placebo-Controlled Trial

Head trauma is a leading cause of trauma related morbidity and mortality worldwide. Tranexamic acid (TXA) inhibits fibrinolysis and can decrease ongoing hemorrhage. In the CRASH-2 Trial, TXA given within 3 hours of injury was shown to decrease mortality from major extracranial injury (CRASH 2 Investigators, Lancet. 2010. PMID: 20554319). A subgroup analysis of the CRASH 2 study that included 270 patients who met criteria for trauma with concern for hemorrhage and a GCS <
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Filed Under: Tags: , October 25th, 2019 Leave a Comment

Delayed Presentations to Emergency Departments of Children with Head Injury: A PREDICT Study

Blunt head trauma in the pediatric patient is a common presentation to emergency departments. Clinical decision rules such as the PECARN rule (Lancet. 2009, PubMed ID: 19758692), CATCH rule (CMAJ 2010, PubMed ID: 20142371) and CHALICE rule (Arch Dis Child 2006, PubMed ID: 17056862) have identified predictor variables for traumatic brain injury on CT (TBI CT)  and clinically important traumatic brain injury (ciTBI).
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Filed Under: Tags: September 20th, 2019 Leave a Comment

Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis

Syncope accounts for a high number of hospital visits yearly and is associated with significant cost. Various syncope decision tools can help clinicians decide which patients are safe to discharge home when no serious cause is identified in the emergency department (ED). However, clinicians have been left without an equivalent of a HEART score (in the case of patients undergoing an ED workup for ACS) to help guide a disposition for patients presenting to the ED with syncope.
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Filed Under: Tags: , September 13th, 2019 Leave a Comment

Dexamethasone in Adults with Bacterial Meningitis

Morbidity and mortality rates are high among adult patients with acute bacterial meningitis especially those with pneumococcal meningitis. Animal studies have shown that bacterial lysis occuring with antibiotic treatment leads to inflammation in the subarachnoid space and that treatment with dexamethasone, an anti-inflammatory agent, reduced cerebrospinal fluid inflammation and neurologic sequelae (Tauber, et al., J Infect Dis.,
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Filed Under: Tags: , August 16th, 2019 Leave a Comment

Cervical Spine Injury Risk Factors in Children with Blunt Trauma

Pediatric cervical spine injuries (CSI) are rare (1-2%) after blunt trauma. Decision rules to identify adults at low risk of cervical spine injury have been developed (NEXUS criteria (Hoffman, NEJM 2000, PMID: 10891516), Canadian C-spine rule (Stiell, JAMA 2001, PMID: 11597285)). A pediatric rule was developed as a subset of the Nexus study (Vicellio, Pediatrics 2001,
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Filed Under: August 8th, 2019 Leave a Comment

Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke

Stroke is one of the leading causes of death in the United States. Approximately 87% of all strokes are ischemic. Available therapies are limited and include thrombolysis and thrombectomy. There is a known risk of hemorrhagic conversion of acute ischemic strokes with the use of thrombolytics. Of the 12 clinical trials comparing thrombolysis vs. either placebo or no treatment for acute ischemic stroke,
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Filed Under: Tags: , , July 5th, 2019 Leave a Comment

Apneic Oxygenation Reduces Hypoxemia During Endotracheal Intubation in the Pediatric Emergency Department

Oxygenation is particularly important in children undergoing endotracheal intubation. They have higher oxygen consumption than adults and become hypoxemic more quickly with rapid sequence intubation. Apneic oxygenation (AO) is the process of providing a high flow rate of oxygen through a standard nasal cannula prior to endotracheal intubation (ETI) without bag-valve mask ventilation. It is thought that the high flow rate results in nitrogen washout (replacing nitrogen with oxygen) which provides an oxygen reservoir as well as provides some degree of positive end expiratory pressure keeping airways open.
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