Retrospective Validation of Brain Injury Guidelines in a Rural Level II Trauma Center.

Introduction: The routine transfer of mild to moderate traumatic brain injuries (TBIs) to trauma centers with neurosurgical capabilities has recently been re-evaluated. The Brain Injury Guidelines (BIG) were developed to categorize TBI patients into three categories (BIG-1, BIG-2, and BIG-3), each representing a progressively increasing risk of clinical deterioration. This classification system has been previously validated at both level I and level III trauma centers.

[Kawasaki's disease. 3 problems: incomplete clinical forms, steroid treatment, low doses of aspirin].

After a brief review of the recent literature and the description of the clinical and echocardiographic follow-up of 9 cases observed from 1976 to 1985, the authors stress the relative importance to recognize patients who do not fulfill the classic criteria for the diagnosis of Kawasaki disease, in order to treat with antiaggregants those affected by coronary aneurysms. Moreover they discuss the beneficial effects of steroids, in association with salicylates, given only in the first two weeks of disease when the production and deposit of immunocomplexes and the release of lysosomal enzymes from macrophage cells occur. Finally the authors point out that the treatment with low doses of salicylates selectively acting on thromboxane A2 and not on Pgl2, as shown in experimental studies, remains to be confirmed by clinical trials.