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Morbidity following minor head trauma in children
four times more likely to be killed than matched sober drivers. When matching only accident type with accident speed, alcohol-involved driver death was 2.2 times more likely. Comparison of serious injuries and deaths with less serious injuries in the entire population reveals alcohol-involved drivers to have 1.7 to 2.1 times higher rates. It was concluded that, in a crash of equal intensity, the drinking driver is more likely to suffer serious injury and death than the nondrinking driver. Mark W Elliott, MD
somatization
S o m a t i z a t i o n : A borderland b e t w e e n m e d i c i n e and p s y c h i a t r y
knees were studied in a plane parallel to the tibial plateau using overlapping scans of from 1 to 2 m m thickness. Of the 209 patients, 150 had bilateral examinations; 59 had examinations of the symptomatic joint only. Of the 359 joints examined, 105 underwent a second procedure, either arthrography, arthroscopy, or both. In 54 of 61 knees with tom menisci, CT findings indicated the correct diagnosis (89% sensitivity). In 43 of 45 normal joints, CT correctly depicted normal menisci (96% specificity). The positive predictive value of CT was 96%. These results compare favorably with both arthr0graphy and arthroscopy. Advantages include cost effectiveness, convenience, and avoidance of an invasive procedure. Disadvantages include the possibility of missing a nondisplaced tear or horizontal lesions. It was concluded that CT scanning is a n efficient and effective method for the identification of meniscus tears. Nicholas ] rouriles, MD
Lipowski ZJ Can Med.Assoc J 135;609-614 Sep 1986 head trauma, children
Recent studies have shown that as many as 30% of primary care patients have a diagnosable psychiatric disorder. Depression and anxiety disorders account for most of these. Furthermore, nearly three of four visits to general practitioners that resulted in a psychiatric diagnosis presented with a physical chief complaint. Chest pain, headache, fatigue, and dizziness were among the most common complaints. Somatization may be transient and precipitated by a stressful situation or may be persistent. Depressive and anxiety disorders are the most common diagnoses made in a patient with somatization, although the patient frequently will deny being depressed or admit that any depression is a result of his physical suffering or disability . A patient may have Both a physical ailment and somatization concurrently, and either may mask the other disorder. Failure to recognize persistent s o m a t i z a t i o n leads to frustration among medical personnel and such derogatory labels for these people as "crocks," "gomers," "tUrkeys," and the "worried well." Frustration among patients leads to doctor shopping and a per capita personal health care expenditure that has been found to be nine times higher in this group as compared with the rest of the population. Paul Howes, MD knee, meniscus tear
M e n i s c u s tears of t h e knee: P r o s p e c t i v e e v a l u a t i o n w i t h CT Manco LG, Kavanaugh JH, Fay JJ, et al Radiology 159:147-151 Apr 1986
A prospective review of computed tomography (CT) scans performed on 209 patients, referred by orthopedic surgeons, with possible meniscus tears of the knee is presented. The 16:1 January 1987
M o r b i d i t y following minor h e a d t r a u m a in children Casey R, Ludwig S, McCormick MC Pediatrics 78:497-502 Sep 1986
This prospective study was designed to describe the incidence and circumstance of minor head trauma and to assess the extent of subsequent physical and functional morbidity. Head trauma was defined as minor if the injury did not result in signs and symptoms of concussion. Those children with altered states of consciousness, skull fracture, and suspected abuse, as well as those requiring admission were excluded. The mean age of the study population was 4.4 years. The male-to-female ratio was 2"1. Half of the injuries occurred at home. A parent or responsible adult was present 40% of the time. Falls accounted for most (52%) of the injuries. Few injuries occurred after 8:00 PM. Physical symptoms attributable to head trauma were rare during the onemonth follow-up period. Headache was the most common complaint (8%). Parents did report increased absenteeism, limitations of play and daily activities, sleep disturbances, moodiness, and discipline problems. This functional morbidity was statistically significantly different from published scores on healthy children. The results indicate that minor head trauma is indeed minor. No patient experienced seizures, diminished level of consciousness, or fainting. However, functional morbidity exists despite the rarity of physical sequelae. The authors conclude that physicians who h a v e determined that a child's head injury is mild should focus parental education on the immediate neurologic signs to observe following the injury, the rarity of physical sequelae, and, hence, the importance of the child's returning to his normal routine.
Annals of EmergencyMedicine
Ronald Ruffing, MD
131/177
somatization
S o m a t i z a t i o n : A borderland b e t w e e n m e d i c i n e and p s y c h i a t r y
knees were studied in a plane parallel to the tibial plateau using overlapping scans of from 1 to 2 m m thickness. Of the 209 patients, 150 had bilateral examinations; 59 had examinations of the symptomatic joint only. Of the 359 joints examined, 105 underwent a second procedure, either arthrography, arthroscopy, or both. In 54 of 61 knees with tom menisci, CT findings indicated the correct diagnosis (89% sensitivity). In 43 of 45 normal joints, CT correctly depicted normal menisci (96% specificity). The positive predictive value of CT was 96%. These results compare favorably with both arthr0graphy and arthroscopy. Advantages include cost effectiveness, convenience, and avoidance of an invasive procedure. Disadvantages include the possibility of missing a nondisplaced tear or horizontal lesions. It was concluded that CT scanning is a n efficient and effective method for the identification of meniscus tears. Nicholas ] rouriles, MD
Lipowski ZJ Can Med.Assoc J 135;609-614 Sep 1986 head trauma, children
Recent studies have shown that as many as 30% of primary care patients have a diagnosable psychiatric disorder. Depression and anxiety disorders account for most of these. Furthermore, nearly three of four visits to general practitioners that resulted in a psychiatric diagnosis presented with a physical chief complaint. Chest pain, headache, fatigue, and dizziness were among the most common complaints. Somatization may be transient and precipitated by a stressful situation or may be persistent. Depressive and anxiety disorders are the most common diagnoses made in a patient with somatization, although the patient frequently will deny being depressed or admit that any depression is a result of his physical suffering or disability . A patient may have Both a physical ailment and somatization concurrently, and either may mask the other disorder. Failure to recognize persistent s o m a t i z a t i o n leads to frustration among medical personnel and such derogatory labels for these people as "crocks," "gomers," "tUrkeys," and the "worried well." Frustration among patients leads to doctor shopping and a per capita personal health care expenditure that has been found to be nine times higher in this group as compared with the rest of the population. Paul Howes, MD knee, meniscus tear
M e n i s c u s tears of t h e knee: P r o s p e c t i v e e v a l u a t i o n w i t h CT Manco LG, Kavanaugh JH, Fay JJ, et al Radiology 159:147-151 Apr 1986
A prospective review of computed tomography (CT) scans performed on 209 patients, referred by orthopedic surgeons, with possible meniscus tears of the knee is presented. The 16:1 January 1987
M o r b i d i t y following minor h e a d t r a u m a in children Casey R, Ludwig S, McCormick MC Pediatrics 78:497-502 Sep 1986
This prospective study was designed to describe the incidence and circumstance of minor head trauma and to assess the extent of subsequent physical and functional morbidity. Head trauma was defined as minor if the injury did not result in signs and symptoms of concussion. Those children with altered states of consciousness, skull fracture, and suspected abuse, as well as those requiring admission were excluded. The mean age of the study population was 4.4 years. The male-to-female ratio was 2"1. Half of the injuries occurred at home. A parent or responsible adult was present 40% of the time. Falls accounted for most (52%) of the injuries. Few injuries occurred after 8:00 PM. Physical symptoms attributable to head trauma were rare during the onemonth follow-up period. Headache was the most common complaint (8%). Parents did report increased absenteeism, limitations of play and daily activities, sleep disturbances, moodiness, and discipline problems. This functional morbidity was statistically significantly different from published scores on healthy children. The results indicate that minor head trauma is indeed minor. No patient experienced seizures, diminished level of consciousness, or fainting. However, functional morbidity exists despite the rarity of physical sequelae. The authors conclude that physicians who h a v e determined that a child's head injury is mild should focus parental education on the immediate neurologic signs to observe following the injury, the rarity of physical sequelae, and, hence, the importance of the child's returning to his normal routine.
Annals of EmergencyMedicine
Ronald Ruffing, MD
131/177