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Clinical characteristics of acute drug-induced dystonia in pediatric patients.

Hyun Woong PARK ; Jae Ryung KWAK ; Ji Sook LEE

Clinical and Experimental Emergency Medicine.2017;4(3):133-137. doi:10.15441/ceem.16.181

OBJECTIVE: Dystonia is a movement disorder in which muscles contract uncontrollably. Acute drug-induced dystonia (DID) can be diagnosed through detailed history taking and physical examination. This study aimed to identify the clinical characteristics of DID in children, which could help emergency physicians diagnose these conditions more efficiently. METHODS: We reviewed medical records of children aged below 18 years diagnosed with drug-related dystonia after discharge from the emergency department over 10 years. We collected the patients’ age, sex, suspected causative drugs, initial diagnosis of the prescribing physician, duration of drug-taking, diagnostic evaluations, treatment methods, and prognosis. RESULTS: Seventy-nine patients were enrolled. The mean age was 11.3±4.9 years (range, 4.0 months to 18.0 years), and 41 patients (51.9%) were boys. The most common cause of DID was gastrointestinal medications in 45 patients (57.0%), followed by antipsychotics in 23 patients (29.1%). Eleven (24.4%) out of 45 patients with DID due to gastrointestinal medications had the initial diagnosis of upper respiratory infection, and seven (30.4%) out of 23 patients with DID due to antipsychotics had the initial diagnosis of non-psychotic diseases. Younger children received more diagnostic procedures and were more frequently admitted. A benzodiazepine (67.1%) was the most common single drug for treatment. CONCLUSION: Physicians should not only acknowledge DID in order to reduce unnecessary workup and admission, but also know that antiemetics and antipsychotics are common causes of DID. Therefore, physicians should try to avoid multidrug prescriptions in children.
Antiemetics ; Antipsychotic Agents ; Benzodiazepines ; Child ; Diagnosis ; Dystonia* ; Emergencies ; Emergency Service, Hospital ; Humans ; Medical Records ; Movement Disorders ; Muscles ; Pharmaceutical Preparations ; Physical Examination ; Prescriptions ; Prognosis

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Single-dose intravenous sodium valproate (Depakine) versus dexamethasone for the treatment of acute migraine headache: a double-blind randomized clinical trial.

Narges KARIMI ; Mahdiye TAVAKOLI ; Jamshid Yazdani CHARATI ; Mastoureh SHAMSIZADE

Clinical and Experimental Emergency Medicine.2017;4(3):138-145. doi:10.15441/ceem.16.199

OBJECTIVE: Migraine headache is a chronic and disabling condition in adults. Some studies have investigated the efficacy of sodium valproate in the treatment of acute migraine, but the effectiveness and tolerability of intravenous valproate as abortive therapy remains unclear. This study aimed to evaluate the effects of sodium valproate and dexamethasone in the treatment of acute migraine. METHODS: We conducted a double-blind randomized clinical trial including 90 patients aged 18 to 65 years with acute migraine headache but no aura. Patients were randomized to receive intravenous dexamethasone (8 mg) or sodium valproate (400 mg) diluted into 4 mL of normal saline. The primary outcome measure was pain relief after 0.5, 1, 3, or 6 hours after administration. The secondary outcome criteria were the associated symptom recovery, rate of headache recurrence after 24 hours, and medication side effects. Pearson’s chi square and the t-test were employed in the data analysis. RESULTS: Of the 90 patients, 80 were investigated. The percentage of headache improvement at 0.5 hours after treatment was 55% and 67.5% in the sodium valproate and dexamethasone groups, respectively. Before-treatment and 0.5 hour after treatment pain severity visual analog scale scores were 9.05±0.90 and 3.8±3.09 in the sodium valproate group and 8.92±0.79 and 3.10±2.73 in the dexamethasone group, respectively. There were no significant intergroup differences. CONCLUSION: This randomized clinical trial showed that the intravenous injection of sodium valproate 400 mg has similar effects to those of dexamethasone for improving acute migraine headache.
Adult ; Dexamethasone* ; Epilepsy ; Headache ; Humans ; Injections, Intravenous ; Migraine Disorders* ; Outcome Assessment (Health Care) ; Recurrence ; Sodium* ; Statistics as Topic ; Valproic Acid* ; Visual Analog Scale

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Emergency department point-of-care ultrasonography improves time to pericardiocentesis for clinically significant effusions.

Evan Avraham ALPERT ; Uri AMIT ; Larisa GURANDA ; Rafea MAHAGNA ; Shamai A GROSSMAN ; Ariel BENTANCUR

Clinical and Experimental Emergency Medicine.2017;4(3):128-132. doi:10.15441/ceem.16.169

OBJECTIVE: Our objective was to determine the utility of point-of-care ultrasound (POCUS) to identify and guide treatment of tamponade or clinically significant pericardial effusions in the emergency department (ED). METHODS: This was a retrospective cohort study of non-trauma patients who were diagnosed with large pericardial effusions or tamponade by the ED physician using POCUS. The control group was composed of those patients later diagnosed on the medical wards or incidentally in the ED by other means such as a computed tomography. The following data were abstracted from the patient’s file: demographics, medical background, electrocardiogram results, chest radiograph readings, echocardiogram results, and patient outcomes. RESULTS: There were 18 patients in the POCUS arm and 55 in the control group. The POCUS arm had a decreased time to pericardiocentesis (11.3 vs. 70.2 hours, P=0.055) as well as a shorter length of stay (5.1 vs. 7.0 days, P=0.222). A decreased volume of pericardial fluid was drained (661 vs. 826 mL, P=0.139) in the group diagnosed by POCUS. CONCLUSION: This study suggests that POCUS may effectively identify pericardial effusions and guide appropriate treatment, leading to a decreased time to pericardiocentesis and decreased length of hospital stay. Pericardial tamponade or a large pericardial effusion should be considered in all patients presenting to the ED with clinical, radiographic, or electrocardiographic signs of cardiovascular compromise.
Arm ; Cardiac Tamponade ; Cohort Studies ; Demography ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Length of Stay ; Pericardial Effusion ; Pericardial Fluid ; Pericardiocentesis* ; Point-of-Care Systems* ; Radiography, Thoracic ; Reading ; Retrospective Studies ; Ultrasonography*

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Review of the potential use of blood neuro-biomarkers in the diagnosis of mild traumatic brain injury.

Alastair JONES ; Paul JARVIS

Clinical and Experimental Emergency Medicine.2017;4(3):121-127. doi:10.15441/ceem.17.226

Head injury is a common presenting complaint amongst emergency department patients. To date, there has been no widespread utilization of neuro-biomarkers to aid the diagnosis of traumatic brain injury. This review article explores which neuro-biomarkers could be used in the emergency department in aiding the clinical diagnosis of mild traumatic brain injury. Based on the available evidence, the most promising neuro-biomarkers appear to be Glial fibrillary acidic protein (GFAP) and Ubiquitin C-Terminal Hydrolase Isozyme L1 (UCH-L1) as these show significant rises in peripheral blood levels shortly after injury and these have been demonstrated to correlate with long-term clinical outcomes. Treatment strategies for minor traumatic brain injury in the emergency department setting are not well developed. The introduction of blood neuro-biomarkers could reduce unnecessary radiation exposure and provide an opportunity to improve the care of this patient group.
Biomarkers ; Brain Concussion ; Brain Injuries* ; Craniocerebral Trauma ; Diagnosis* ; Emergency Service, Hospital ; Glial Fibrillary Acidic Protein ; Humans ; Radiation Exposure ; Ubiquitin Thiolesterase