| Title | Minimal head injury: is admission necessary? | | Author(s) | Livingston DH, Loder PA, Hunt CD | | Institution | Department of Surgery, UMD-New Jersey Medical School, Newark. | | Source | Am Surg 1991 Jan; 57(1):14-7. | | MeSH | Adolescent
Adult
Brain Injuries
Cerebral Hemorrhage
Child
Child, Preschool
Craniocerebral Trauma
Emergency Service, Hospital
Female
Follow-Up Studies
Glasgow Coma Scale
Health Services Needs and Demand
Hematoma
Humans
Male
Middle Aged
Neurologic Examination
Patient Admission
Skull Fractures
Tomography, X-Ray Computed
Triage
Unconsciousness
| | Abstract | The records of 138 patients admitted a Glasgow Coma Score (GCS) of 14 or 15 following head injury were reviewed to assess the need for hospital observation and to determine whether obtaining a normal computerized tomography (CT) scan in the emergency department could have avoided admission. GCS was 15 in 103 patients (74%) and 14 in 35 (26%). Eighty-three patients were admitted for their head injury alone, and 55 had other injuries but would have required admission for their head injury. Loss of consciousness was documented in 51 per cent and suspected in another 29 per cent and was distributed equally regardless of GCS. Seven per cent (5/71) of skull x rays were positive and were associated with CNS pathology in three patients. Skull x rays in an additional four patients with positive CT findings were negative including a patient with an epidural hematoma (EDH). Seventeen per cent (13/75) of CT scans were positive (contusions 5, subdural hematoma 3, subarachnoid hemorrhage 2, edema 2, EDH 1). Only the patient with the EDH required operative treatment. No patient with a normal CT scan went on to develop any neurosurgical problems, and 78 per cent of the patients admitted with isolated head injuries were discharged within 48 hours. Significant CNS pathology does occur following "minimal" head injuries. Skull x rays are not helpful. The use of CT scanning appears to triage those patients requiring admission and in hospital observation. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 1796791 |
|
