CME 26/02/15 – Significance of pupillary dilatation in head trauma
Here is Tom’s talk on the significance and prognostic implications of fixed dilated pupils in patients with intracranial haemorrhage. This talk was predominantly based around a recent paper : Scotter et al, Prognosis of patients with fixed dilated pupils secondary to traumatic extradural or subdural haematoma who undergo surgery: a systematic review and meta-analysis, Emerg Med J, 2014. However, this was used as a nidus for a discussion on considerations in deciding on aggressive versus conservative management of this patient group.
Resources:
- Types of Brain Herniation:
- Causes of a single fixed dilated pupil from LITFL
- Cliff Reid’s (Resus.me) take on the above systematic review and meta-analysis – “Bilateral fixed dilated pupils? Operate if extradural!”
- Traumatic Brain Injury (TBI) Prognosis from LITFL:
- CRASH head injury prognosis calculator
- generated from: Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ 2008; 336
- IMPACT head injury prognosis calculator
- Based on extensive prognostic analysis the IMPACT investigators have developed prognostic models for predicting 6 month outcome in adult patients with moderate to severe head injury (Glasgow Coma Scale <=12) on admission
- CRASH head injury prognosis calculator
