This week in the BMJ

Volume 333, Number 7566, Issue of 2 Sep 2006

[Down]Triaging patients with mild head injury with CT is effective...
[Down]...and about a third less expensive than admission for observation
[Down]Stimulating stunted toddlers improves later psychosocial functioning
[Down]Are the dangers of childhood food allergy exaggerated?
[Down]Preventing and detecting complications of diabetes

Triaging patients with mild head injury with CT is effective...

Use of computed tomography during triage for admission of patients with mild head injury is feasible and leads to similar clinical outcomes compared with observation in hospital. Af Geijerstam and colleagues (p 465) randomised 2602 patients aged 6 years or older with mild head injury to immediate computed tomography or admission for observation at 39 Swedish centres. At three months, 21.4% of those in the computed tomography group had not recovered completely, compared with 24.2% of those admitted for observation. Mortality, severe loss of function, and patient satisfaction were similar in the two groups.


Figure 1
 Credit: PLAINPICTURE/KG/ALAMY

 



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...and about a third less expensive than admission for observation

In a related prospective cost effectiveness analysis, Norlund and colleagues (p 469) compared the costs of immediate computed tomography during triage of patients with mild head injury with those of observation in hospital, and they found computed tomography to be more cost effective. The costs per patient for the acute stage of management and complications were {euro}461 (£314, $582) in the computed tomography group and {euro}677 (£462, $854) in the observation group. After three months, total costs per patient were {euro}718 and {euro}914 respectively.



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Stimulating stunted toddlers improves later psychosocial functioning

Psychosocial stimulation in early childhood has long term benefits to growth retarded (stunted) children's emotional outcomes and attention. Walker and colleagues (p 472) undertook a 16 year follow-up study of a randomised controlled trial comparing dietary supplementation (1 kg of milk based formula a week) or psychosocial stimulation (weekly play sessions with mother and child), or both, for two years as treatment for stunted children aged 9-24 months in poor neighbourhoods in Kingston, Jamaica. In late adolescence, participants who received stimulation reported less anxiety, less depression, and higher self esteem than those who did not. Dietary supplementation had no sustained effect.


Figure 1
 Credit: MARC FRENCH/PANOS PICTURES

 



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Are the dangers of childhood food allergy exaggerated?

The risk of dying from food allergy reactions is small. There are effective and simple measures available to reduce risk, but no tests exist to predict severity of reaction. Colver and Hourihane debate what proportion of children with food allergy should be prescribed an adrenaline autoinjector as emergency prophylaxis (p 494 and p 496). Colver believes that the increasing prescription of emergency prophylaxis to children fuels anxiety rather than saving lives, but Hourihane argues that there are no data to show that prescription of autoinjectors increases anxiety and that their provision, as part of an integrated care plan, is justified.


Figure 1
 Credit: PHOTOS.COM

 



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Preventing and detecting complications of diabetes

Diabetes reduces people's life expectancy by 5-10 years, mainly because of vascular complications. In this clinical review (p 475), Marshall and Flyvbjerg revisit the macrovascular and microvascular complications of diabetes and explore their risk factors and pathophysiology. The authors present the main strategies for preventing, detecting, and managing early complications and discuss why diabetes care is generally poor worldwide and how this can be improved.


Figure 1
 Credit: SPL

 



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