Well to be fair to them James, kids' assessment is a complete nightmare, and
a frequent source of litigation I can tell you. For a start, GCS is next to
useless in smaller kids, then you have the infants who are intermittently
sleepy as a matter of course, then you have some juniors getting confused,
as they mistakenly believe that GCS is based on the "best response", which
effectively means that they will underestimate injury severity.
On the other hand, kids are notoriously somnolent and nauseated post
concussional head injury, so a modicum of conservatism is quite sensible for
the vast majority. But serious brain injuries are missed in kids on a
regular basis (nationally I mean) largely because people don't act when a
kid is clearly persistently drowsy post head injury. Listen carefully to
what the parents think the child's like compared to normal, that's my only
useful advice to add.
Adrian Fogarty
----- Original Message -----
From: "James McFetrich" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, September 19, 2007 5:14 PM
Subject: Re: NICE Head Injury Guidelines
> Prof Mendelow, a Newcastle Neurosurgeon who sits on the NICE HI group gave
> a
> brief summary of the new guidelines at the Trainees conference last week.
>
> The adult guidelines essentially make a bit more sense so you don't CT
> anyone of 65 immediately just because of their age. Unfortunately this has
> come through on the actual guideline by different colours signifying
> different time periods in which to do the scan - of course the NHS rarely
> photocopies or prints in colour ...
>
> The child guidelines essentially adopt the CHALICE rule, admitting there
> is
> not much evidence for them but still having them in there. There is a
> delightfully vague "Abnormal drowsiness" which gets you an immediate CT
> scan.
>
> Official publication of guidelines next week which is a miracle
> considering
> it is the first NICE guideline to go through a 2nd process and Sept 2007
> is
> when they said it would be published. Wonders will never cease.
>
> James
>
> James McFetrich
> SpR Emergency Medicine
> Northern Deanery
>
> [log in to unmask]
>
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Adrian Boyle
> Sent: 18 September 2007 09:31
> To: [log in to unmask]
> Subject: Re: NICE Head Injury Guidelines
>
> I hope they will be a bit more credible about CT scanning
> in children and acknowledge the paucity of evidence.
>
>
>
> On Tue, 18 Sep 2007 09:20:56 +0100
> "McCormick Simon Dr, Consultant, A&E"
> <[log in to unmask]> wrote:
>> I understand the review of the NICE guidelines is due
>>out any time soon.
>> Does anyone expect any major changes from the current
>>position?
>> Will they be more, or less CT happy?
>>
>> Simon
>>
>>
>>
>>
>
>
>
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>
>
>
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