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S J Masters

Publications and source records attributed to S J Masters.

8 recordsLinked to original sources
PubMed1987

Skull x-ray examinations after head trauma. Recommendations by a multidisciplinary panel and validation study.

The value of skull radiography in identifying intracranial injury has not yet been satisfactorily defined. A multidisciplinary panel of medical experts was assembled to review the issue of skull radiography for head trauma. The panel identified two main groups of patients--those at high risk of intracranial injury and those at low risk of such injury--and developed a management strategy for imaging in the two groups. The high-risk group consists primarily of patients with severe open or closed-head injuries who have a constellation of findings that are usually clinically obvious. These patients are candidates for emergency CT scanning, neurosurgical consultation, or both. The low-risk group includes patients who are asymptomatic or who have one or more of the following: headache, dizziness, scalp hematoma, laceration, contusion, or abrasion. Radiographic imaging is not recommended for the low-risk group and should be omitted. An intermediate moderate-risk group is less well defined, and skull radiography in this group may sometimes be appropriate. A prospective study of 7035 patients with head trauma at 31 hospital emergency rooms was conducted to validate the management strategy. No intracranial injuries were discovered in any of the low-risk patients. Therefore, no intracranial injury would have been missed by excluding skull radiography for low-risk patients, according to the protocol. We conclude that use of the management strategy is safe and that it would result in a large decrease in the use of skull radiography, with concomitant reductions in unnecessary exposure to radiation and savings of millions of dollars annually.

Brain Injuries↗
PubMed1984

Skull fracture and the low risk of intracranial sequelae in minor head trauma.

The presence of skull fracture has been associated with a higher risk of intracranial sequelae than if a fracture were not present. This is true for the total population of head-injury patients. However, reanalysis of the patient selection criteria data from two large published series on skull imaging in head trauma revealed that this increased risk factor for intracranial sequelae did not apply to a specific subset of minor-head-trauma patients. The patients in this subset were characterized by the presence of one or more of five "low-yield" criteria: (1) asymptomatic (no complaints), (2) headaches, (3) dizziness, (4) scalp hematoma, and (5) scalp laceration. All other criteria were absent. Results of the reanalysis showed (from a total population of 3031 head-trauma patients) a subset of 1184 patients characterized by these five criteria. In these 1184 minor-head-trauma patients there were 19 fractures, all linear, with none depressed or basilar. There were no intracranial sequelae. This change in the concept of fracture as a risk factor for intracranial sequelae has major implications in the future development of strategies for selecting patients for not having skull films or head computed tomograms.

Brain Injuries↗
PubMed1981

Radiographic findings and etiologic diagnosis in ambulatory childhood pneumonias.

The chest roentgenograms of 128 consecutive ambulatory children with radiologic pneumonia were read independently and without clinical information by a faculty general pediatrician (Ped), a pediatric radiologist (R-P) and a general radiologist (R-G). The films were classified as normal, indicative of a viral or bacterial process, or indeterminate. Readings were compared with results of viral titers and bacterial cultures. Agreement between any two observers in classifying films, measured by unweighted Kappa, while statistically significant (p less than 0.001) for any pair, was low. There was no significant difference between the agreement scores of Ped/R-P, Ped/R-G, and R-P/R-G. Twenty-one patients had fourfold viral titer increases (N = 16) or positive bacterial cultures of blood or pulmonary aspirate (N = 5). The sensitivity of viral readings for titers increases varied from 19% to 68% depending on observer type; the sensitivity of bacterial readings for positive bacterial cultures varied from 60% to 80%. The three observers agreed on a correct reading in only three children with viral and three with bacterial pneumonia. Because of poor observer agreement and appreciable false-negative errors when viral and bacterial readings were compared to titer increases and positive bacterial cultures, respectively, we conclude that radiographic findings are poor indicators of etiology diagnosis in ambulatory childhood pneumonias and, of themselves, are an insufficient data base for making therapeutic decisions.

Child↗
PubMed1980

Evaluation of head trauma: efficacy of skull films.

A retrospective review of 1,845 patients was performed to evaluate the efficacy of skull films in acute head trauma. The implications of efficacy included effects on diagnosis, therapy, and ultimate outcome. Seventy-nine patients had skull fractures. Thirty-three patients sustained significant intracranial sequelae from their injuries, but only seven of these also sustained fractures. Twenty-six patients had significant intracranial sequelae but no skull fracture. In none of the 33 patients with significant intracranial sequelae was management or outcome affected by skull film findings. Of 1,845 patients, seven (0.38%) had basilar fractures requiring antibiotics. These were the only patients whose treatment and outcome were apparently altered by radiographic findings. Skull fractures alone seldom indicate more serious internal head injury. Routine skull films after head trauma are not effective contributors to the evaluation, management, or outcome of acute intracranial injury. "High--yield" clinical criteria are offered for predicting patients at risk for significant intracranial sequelae. If any of the "high-yield" features for significant intracranial sequelae are present, computed tomography should be considered as the primary, noninvasive diagnostic procedure of choice. The poor correlation of skull fracture with significant intracranial sequelae suggests that, for a select subgroup of patients, skull fracture may protect against significant intracranial sequelae.

Brain Injuries↗