Reducing one source of pediatric head injuries

Evaluation of a school-based, bicycle helmet program was conducted using the PRECEDE model. The intervention targeted schools with low income, high minority, and nonurban fourth grade children. A repeated measures design was used with schools randomly assigned to each treatment: classroom, parent-classroom, or control. Reported helmet use was approximately 18% prior to the program. Following the intervention, between 34% and 98% of intervention students reported helmet use, with the best results reported in schools with parental contact. This educational intervention coupled with the provision of bicycle helmets increased reported helmet use, especially when parental contact was added.     

Necessity of hospital admission for pediatric minor head injury

The objective of this study was to evaluate the need for mandatory hospital admission of all pediatric patients with minor head injury (MHI) and negative computed tomographic (CT) scans for head injury. The study was a retrospective chart review of all patients admitted to a pediatric trauma service over a period of 4 years. MHI was defined as blunt head trauma with a Glasgow Coma Scale (GCS) score of 15 and a nonfocal neurological examination. Only patients < or = 13 years of age and with a negative head CT scan were included, and during hospitalization all patients were observed for delayed complications. A total of 197 patients met the inclusion criteria. The patients' mean age was 7.1 years, with a range of 2 months to 13 years. The most common mechanisms of injury were being struck by a motor vehicle while walking (82 patients), and falling (75 patients). No complications were observed, and although persistent symptoms occurred in 5 patients, they did not delay discharge. We conclude that pediatric patients with MHI and negative CT scans of the head do not require routine admission for observation for delayed complications.     

Emergency management of minor head injury in anticoagulated patients

Approximately 1% of the UK population receives anticoagulation with warfarin. Head injury accounts for some 1.4 million emergency department attendances in the country. Therefore, significant numbers of patients with head injury have a therapeutic coagulopathy. This review aims to examine the existing evidence for optimal management of warfarinised head injured patients, particularly with respect to the need for early CT imaging and the use of reversal agents in cases of proved haemorrhage.     

Current trends in management of pediatric asthma

Though asthma cannot be cured, it can be effectively controlled with existing treatments. Management strategies for acute and chronic asthma often vary substantially within and among medical facilities and practices, often driven by physician preference and familiarity rather than by data. The use of carefully designed care paths can improve quality of care and decrease management costs of acute asthma in both the emergency department and in-patient setting. Using newer beta agonists and attention to proper inhalation delivery systems may also improve outcomes and patient satisfaction. Assessment-driven care paths can be safely and effectively administered by respiratory therapists and nurses. The major controversies in the management of chronic asthma center on what to do for the patient who fails to respond to low or moderate doses of inhaled corticosteroids. The addition of a long-acting beta agonist or a leukotriene receptor antagonist may be beneficial.     

Initial management of pediatric head trauma.

Head injuries are the most common cause of disability and death in children. Identification of children who require specialized management following a head injury will reduce the associated morbidity and mortality. Thus, it is important to differentiate the child who can be safely observed and who will recover spontaneously from the child who will develop a progressive neurologic deficit from a treatable cause. A thorough history, a tailored neurologic examination and limited radiographic studies will assist the family physician in making this determination.     

Validity of serum tau protein levels in pediatric patients with minor head trauma

Background

The aim of this study was to investigate the relationship between intracranial injury and serum tau protein levels in pediatric patients with minor head trauma (MHT).

Methods

We included 60 pediatric patients with MHT (Glasgow Coma Scale [GCS], 14-15) and 28 control patients. The patients were divided into 3 groups as follows: those without (group 1) and with (group 2) intracranial lesions shown on cranial computed tomography (CCT) and the control group (group 3).

Results

The mean serum tau protein level was 96.06 ± 70.36 pg/mL in group 1, whereas it was 112.04 ± 52.66 pg/mL in group 2, with no statistically significant difference between the groups (p = .160). The mean serum tau protein levels between the study groups (group 1 and group 2) and control (38.52 ± 29.01) were statistically significant (P < .001 and P < .001, respectively). The GCS score and pathologic condition in CCT were only influential variables on tau protein levels.

Conclusions

We found that serum tau protein increased after MHT but did not distinguish between those with and those without intracranial lesions demonstrable on CCT.     

Current management of status asthmaticus in the pediatric ICU

Status asthmaticus (SA) in the pediatric ICU (PICU) can progress to a life-threatening emergency. The goal of management is to improve hypoxemia, improve bronchoconstriction, and decrease airway edema through the administration of continuous nebulized beta2 adrenergic agonist with intermittent anticholinergics, corticosteroids, and oxygen. Adjunctive therapies, such as magnesium, methylxanthines, intravenous beta-agonists, heliox, and noninvasive ventilation should be considered in the child who fails to respond to initial therapies. The restoration of adequate pulmonary functions, resolution of airway obstruction, and avoidance of mechanical ventilation should guide management. This article reviews the pathophysiology, assessment, and management of the child who has SA in the PICU to provide the critical care nurse with current information to facilitate optimal care.     

Current status and controversies on the management of cerebral main trunk occlusion

Management of the cerebral main trunk occlusive disease has proceeded during last decade owing to remarkable progress of diagnostic and interventional neuroradiology. Several large clinical trials have established treatment guidelines in most of stroke management. Concerning cerebral main trunk occlusion, management of acute embolic ischemia and surgical indication for chronic carotid artery occlusion has still remained unsettled. In this article, outline of previous discussion and current status and controversies are reviewed.