12 research outputs found

    Routine repeat head CT may not be necessary for patients with mild TBI.

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    Background:Routine repeat cranial CT (RHCT) is standard of care for CT-verified traumatic brain injury (TBI). Despite mixed evidence, those with mild TBI are subject to radiation and expense from serial CT scans. Thus, we investigated the necessity and utility of RHCT for patients with mild TBI. We hypothesized that repeat head CT in these patients would not alter patient care or outcomes. Methods:We retrospectively studied patients suffering from mild TBI (Glasgow Coma Scale (GCS) score 13-15) and treated at the R Adams Cowley Shock Trauma Center from November 2014 through January 2015. The primary outcome was the need for surgical intervention. Outcomes were compared using paired Student's t-test, and stratified by injury on initial CT, GCS change, demographics, and presenting vital signs (mean ± SD). Results:Eighty-five patients met inclusion criteria with an average initial GCS score=14.6±0.57. Our center sees about 2800 patients with TBI per year, or about 230 per month. This includes patients with concussions. This sample represents about 30% of patients with TBI seen during the study period. Ten patients required operation (four based on initial CT and others for worsening GCS, headaches, large unresolving injury). There was progression of injury on repeat CT scan in only two patients that required operation, and this accompanied clinical deterioration. The mean brain Abbreviated Injury Scale (AIS) score was 4.8±0.3 for surgical patients on initial CT scan compared with 3.4±0.6 (P<0.001) for non-surgical patients. Initial CT subdural hematoma size was 1.1±0.6 cm for surgical patients compared with 0.49±0.3 cm (P=0.05) for non-surgical patients. There was no significant difference between intervention groups in terms of other intracranial injuries, demographics, vital signs, or change in GCS. Overall, 75 patients that did not require surgical intervention received RHCT. At 340perCT,340 per CT, 51 000 was spent on unnecessary imaging ($367 000/year, extrapolated). Discussion:In an environment of increased scrutiny on healthcare expenditures, it is necessary to question dogma and eliminate unnecessary cost. Our data questions the use of routine repeat head CT scans in every patient with anatomic TBI and suggests that clinically stable patients with small injury can simply be followed clinically. Level of evidence:Level III

    The Impact of Mercenaries and Private Military and Security Companies on Civil War Severity between 1946 and 2002

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    Research has long abandoned the view that only states wage war. On the contrary, civil war research has produced an impressive body of literature on violent non-state actors. Still, a particular group of actors—mercenaries—has been widely neglected so far, although they have participated in numerous conflicts in the second half of the twentieth century. Whether their presence aggravated or improved the situation is a matter of dispute. Some believe that the additional military capabilities provided by mercenaries help to end civil wars quickly without increased bloodshed, while others deem mercenaries greedy and bloodthirsty combatants who contribute to making civil wars more brutal, while a third opinion differentiates between different types of mercenaries. This article tests the impact of mercenaries on civil war severity. The evidence indicates that the presence of both mercenaries and private military and security contractors increases its severity
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