Compression Rate Matters for Out-of-Hospital Cardiac ArrestFaster is better, but only up to a point.
Intraventricular Hemorrhage After Blunt Head Trauma in ChildrenChildren with isolated intraventricular hemorrhage had better outcomes than children with additional intracranial injuries.
Bedside Web-Based Model Predicts Mortality in Patients with Traumatic Bleeding
The strongest mortality predictors were Glasgow Coma Scale score, age, and systolic blood pressure.Rapid identification of patients at risk of dying from traumatic bleeding is essential to guide initial management and avoid preventable death. To develop a prognostic model for such patients, investigators met with prehospital, battlefield, and emergency department personnel to identify variables they considered important and convenient for assessing risk from traumatic bleeding. To identify which factors predicted in-hospital death within 4 weeks of injury, the researchers performed multivariable logistic regression analyses using data from the CRASH-2 trial cohort of 20,127 trauma patients (age >15) with estimated blood loss of at least 20%. The authors externally validated the model in 14,220 patients (primarily from the U.K.) from the Trauma Audit and Research Network. Patients with isolated closed limb injuries and those aged >65 years with isolated fracture of the pubic ramus or neck of femur were excluded from the analysis.
Medicare's Efficiency Measure for Head CT for Atraumatic Headache Is Profoundly Flawed
A multicenter review of medical records shows that the measure is wildly unreliable, invalid, and inaccurate.As part of their initiative to publically report and eventually pair reimbursement with specific quality and efficiency measures, the Centers for Medicare and Medicaid Services (CMS) developed an efficiency measure to evaluate use of brain computed tomography (CT) for emergency department (ED) patients who present with atraumatic headache. The measure (CMS OP-15) uses administrative billing data for patients with a final diagnosis of nonspecific headache. A CT scan is not included in the calculation (i.e., considered appropriate) if the patient has any of the following exclusions, which were derived based on guideline review and expert opinion: headache associated with lumbar puncture, dizziness, paresthesia, lack of coordination, subarachnoid hemorrhage, complicated or thunderclap headache, focal neurologic deficit, pregnancy, HIV, tumor or mass, or CT scan related to reason for admission. The National Quality Forum (NQF), which typically reviews and approves all measures for the CMS, rejected the proposed measure because it lacked scientific validity. The CMS implemented the measure despite the NQF finding.
Not at all.Distinguishing between peripheral and central causes of vertigo is challenging, and computed tomography (CT) is often used in the hope of providing key discriminatory information. Researchers reviewed the charts of 448 patients who underwent CT for dizziness at an academic emergency department to determine if a cause was identified and if follow-up imaging (performed in 104 patients) led to a change in diagnosis.
Low Prevalence of Head CT Findings in ED Patients Without Trauma
Fewer than 10% of patients had clinically important findings, but unfortunately, this study's design limits the applicability of its findings.
In a retrospective chart review, researchers assessed the prevalence of clinically important head computed tomography (CT) findings and how often they lead to emergent interventions in emergency department (ED) patients without trauma. During the 1-year study period, 766 adult patients who presented to a single academic ED without trauma and underwent head CT at the discretion of the treating physician (usually a resident) before admission were enrolled.