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BACKGROUND: There is uncertainty about which children with minor head injury need to undergo computed tomography (CT). We sought to prospectively validate the accuracy and potential for refinement of a previously derived decision rule, Canadian Assessment of Tomography for Childhood Head injury (CATCH), to guide CT use in children with minor head injury. METHODS: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Physicians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule. RESULTS: Of 4060 enrolled patients, 23 (0.6%) underwent neurosurgical intervention, and 197 (4.9%) had brain injury on CT. The original 7-item rule (CATCH) had sensitivities of 91.3% (95% confidence interval [CI] 72.0%-98.9%) for neurosurgical intervention and 97.5% (95% CI 94.2%-99.2%) for predicting brain injury. Adding '[greater than or equal to] 4 episodes of vomiting' resulted in a refined 8-item rule (CATCH2) with 100% (95% CI 85.2%100%) sensitivity for neurosurgical intervention and 99.5% (95% CI 97.2%-100%) sensitivity for brain injury. INTERPRETATION: Among children presenting to the emergency department with minor head injury, the CATCH2 rule was highly sensitive for identifying those children requiring neurosurgical intervention and those with any brain injury on CT. The CATCH2 rule should be further validated in an implementation study designed to assess its clinical impact., Pediatric head injury accounts for more than 500 000 emergency department visits annually in the United States. (1) Most head injuries are mild and do not require neurosurgical management. However, [...]

Although there are notable physiologic and anatomic variances between human and veterinary patients, possessing a clear and refined veterinary cardiopulmonary resuscitation (CPR) treatment strategy can help promote a successful outcome. [...]

This second in a two-part series of 'mini' OEC articles will give you a sample of the new changes in the Outdoor Emergency Care Fifth Edition. The first series of [...]

Although we are used to caring for patients with ocular emergencies, many of us have limited experience in treating systemic emergencies that occur within or outside the office. Still, appropriate [...]

EXECUTIVE SUMMARY Current guidelines for acute stroke care are not being followed in community EDs, with time targets for diagnostic tests significantly longer than recommended, according to a just-published study. [...]

EXECUTIVE SUMMARY When caring for trauma patients with life-threatening injuries, know which interventions must be done before patients are taken to surgery. * Although tachycardia is the key clinical sign [...]

EXECUTIVE SUMMARY Patients with sickle cell disease often are viewed as drug seekers, so you must advocate for appropriate pain management. * Ask patients if pain is typical for when [...]

Debate: Direct Cath Lab Activation by Paramedics Should paramedics be empowered to activate cath labs directly, or should field ECGs be reviewed by physicians first? Two top docs weigh the [...]

What are they? Currently there are a number of ways through which clinicians may be made aware of important issues -- by journals, conferences, working parties and the minutes of [...]

The publication of the NHS Plan in August 2000 represents the first attempt by an administration of any persuasion to undertake a comprehensive review of the current state of play [...]

EXECUTIVE SUMMARY If an on-call physician does not respond as required by the Emergency Medical Treatment and Labor Act, you are obligated to notify appropriate individuals. * Develop a reporting [...]

In order to best prepare for the diagnosis of patients having a heart attack and related complications, over 400 patients with suspected myocardia infarction (heart attack) were categorized into low, intermediate and high risk groups according to previously developed criteria relating to the patients' electrocardiogram (ECG), which reflects the electrical activity of the heart. Compared to patients with normal ECGs, patients with positive ECGs (indicating myocardial infarction) had a three times greater risk of requiring additional treatment, a greater risk of life-threatening complications and a 14 times greater risk of having myocardial infarction. Compared to patients with abnormal ECGs, the patients with positive ECGs had nearly a two times greater risk of requiring additional treatment, a two-and-one-half times greater risk of life-threatening complications and a five times greater risk of having myocardial infarction. Assigning 'high' risk to any patient who required treatment during the initial emergency evaluation improved the ability to predict which patients were at greater risk of having myocardial infarction. Risk for the remainder of patients was assigned according to the ECG criteria, with normal ECG having low risk, abnormal ECG having intermediate risk and positive ECG having a high risk. Hospitals with a limited number of intensive care beds may be able to use these predictive guidelines for determining admissions and transfers for patients with suspected acute myocardial infarction.

WASHINGTON -- The International Council of Cruise Lines said the shipboard medical guidelines adopted for its 19 member lines were designed "to foster reasonable emergency medical care for passengers and […]