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Chapter 20 - Abusive head trauma: intracranial imaging strategies
- from Section II - Abusive head and spinal trauma
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- By V. Michelle Silvera, Staff Pediatric Neuroradiologist at Boston Children’s Hospital and Assistant Professor of Radiology at Harvard Medical School, Boston, Massachusetts, USA, P. Ellen Grant, Director, Center on Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital and Associate Professor of Radiology at Harvard Medical School, Boston, Massachusetts, USA, Gary L. Hedlund, Chief of Neuroimaging at the Primary Children’s Medical Center and Adjunct Professor of Radiology at the University of Utah, Salt Lake City, Utah, USA, Paul K. Kleinman, Department of Radiology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
- Edited by Paul K. Kleinman
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- Book:
- Diagnostic Imaging of Child Abuse
- Published online:
- 05 September 2015
- Print publication:
- 03 September 2015, pp 487-493
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- Chapter
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Summary
Introduction
How and when to image the head in infants and children with suspected abusive head trauma (AHT) has become more complex with the increasing widespread availability of robust and elegant imaging technologies. These complex decisions are generally individualized based on available resources and expertise. The evidence base is modest with respect to the comparative diagnostic performance of the various neuroimaging modalities or magnetic resonance imaging (MRI) sequences in this specific context (1–5). Based on the available literature and the expertise of a panel of experts, the American College of Radiology (ACR) has put forth “Appropriateness Criteria” for imaging AHT and the organization periodically updates their recommendations in light of new data (6, 7). The goal of this chapter is to provide guidance to imaging departments that reflects the authors’ experience in light of current knowledge. Imaging strategies with respect to the skull, scalp, and subscalp have been covered in Chapter 17 – this discussion will focus on the approach to imaging the intracranial alterations described in Chapters 18 and 19. Craniocervical junction and spinal imaging strategies are addressed in Chapter 21.
Sonography
Sonography is a valuable imaging tool used to assess children with suspected AHT. The anterior and posterior fontanels and squamosal portions of the temporal bones (transmastoid) serve as natural acoustic windows for cranial sonography in infants up to six months of age. Cranial sonography is a low-cost, noninvasive modality that can be performed at the bedside without sedation, and is particularly useful in evaluating children with severe AHT in the intensive care unit who are too unstable for transport to the radiology department and prolonged imaging in the MRI suite. This modality allows for prompt assessment of hydrocephalus, some subdural hematomas (SDHs), parenchymal abnormalities, and mass effect; and can detect small white matter lacerations (contusional tears) – lesions that may go undetected on head computed tomography (CT) and are considered highly suggestive of inflicted injury (8). Color and spectral Doppler analysis provide useful information with regard to cerebral blood flow and readily detect occlusive thrombosis of the superior sagittal venous sinus.
Development of an Equipment and Supply List for Emergency Medical Services Delivery at an Annual Air Show
- Francis M. Sullivan, Gary Kleinman, Selim Suner, Jack St.Jean
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- Journal:
- Prehospital and Disaster Medicine / Volume 14 / Issue 2 / June 1999
- Published online by Cambridge University Press:
- 28 June 2012, pp. 68-71
- Print publication:
- June 1999
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- Article
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Introduction:
Reports of medical care at mass gatherings reflect variability in mission and delivery models. Equipment recommendations are similarly varied. Thoughtful pre-planning and experience-based analysis are the best mechanisms for defining general and specific equipment recommendations.
Objective:This report presents a suggested supply and equipment list developed over a six-year period of medical coverage at an air show, with an emphasis on the usage and cost of expendable supplies.
Methods:The authors were involved in the planning for and execution of emergency medical care for a large, local, military air show on an annual basis, including provision of expendable medical supplies. A list of such supplies was developed over the initial two to three years, formalized and refined over the subsequent two years, and analyzed in the final, highest patient volume year of coverage. Detailed usage and cost was tracked over the final year for expendable supplies.
Results:The results of this analysis indicate that comprehensive emergency medical care from first aid to mass casualty care can be offered at reasonable equipment and supply costs, if existing equipment resources can be supplemented by expendable supplies from a pre-determined list. Given the need for large quantities of supplies for a mass casualty contingency and the low likelihood of occurrence, a loan arrangement with a supplier, with return of unused supplies, is particularly convenient and economical. The approach used in this study should be appreciable in other similar settings. In concurrent scheduled events, the iterative process described can lead to greater specificity of needs for expendable supplies.