Welcome to REBELCast August 2014, where Matt, Swami, and I are going to tackle a couple more scenarios to help your clinical practice. Today, we are going to specifically tackle two different topics:
Topic #1: Significance of Isolated Vomiting in Pediatric Minor Head Trauma
Topic #2: Early Detection of Systemic Inflammatory Response Syndrome (SIRS) in the Emergency Department
REBELCast August 2014 Podcast
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What are the clinical questions that will be covered in REBELCast Episode 2?
Question #1: What is the risk of significant intracranial injury in pediatric patients who present with minor head trauma and isolated vomiting?
Question #2: What percentage of patients presenting to the emergency department with SIRS, actually have an infectious etiology?
What are the specific articles we will be covering?
Article #1: Dayan PS et al. Association of Traumatic Brain Injuries with Vomiting in Children with Blunt Head Trauma. Ann EM 2014; 63: 657 – 65. (24559605)
Article #2: Horeczko T et al. Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the Emergency Department. West J Emerg Med 2014; 15 (3): 329 – 336. (24868313)
What are the clinical bottom lines for the above clinical questions:
Bottom Line #1: Pediatric patients with minor head trauma and isolated vomiting are at an extremely low risk for clinically significant traumatic brain injury. It may be reasonable to manage these patients with ED observation followed by home observation instead of with immediate CT scan of the head.
Bottom Line #2: SIRS may value as an early screening test (fairly sensitive) for identifying patients with higher rates of hospitalization, need for critical care, and short-term mortality, but without the combination of clinical judgment, alone is not useful as a diagnostic tool for infection (poorly specific).