Mild Head Injury: CT scanning and Discharge at Emergency Room

ABSTRACT

We studied retrospectively 1,112 mild head injury patients visited during a 2-year period to Dankuk University Medical Center to determine the clinical value of routine computerized tomography(CT) of the head and the indication of early discharge in patients with mild head injury(Glasgow coma scale score>or=13) at emergency room. Routine urgent cranial CT scans were obtained on all patients. Variables reviewed were mental status, symptom & sign of head trauma(brief loss of consciousness(LOC), amnesia, nausea and vomiting, headache). skull fracture on skull radiology, intracranial lesions, and operation. Patients with 13-14 Glasgow coma scale(GCS) or skull fracture have a significantly higher incidence of intracranial lesions and operation. Thus we suggest classifing patients with a GCS of 13-14 or skull fracture into "moderate" rather than "mild" in severity and recommend performing CT in all those patients. The patients with normal mental status(GCS score of 15) and no skull fracture have a rate of abnormal CT finding of 8.5% in the subgroup with history of LOC/amnesia and symptoms of head injury, but no patient in the subgroup without LOC/amnesia and symptoms of head injury. There was a few occurrence of delayed intracranial hematoma in normal mental status, but no patient required surgical intervention. We conclude that routine CT of the head in patients with GCS score of 13-14, skull fracture, and history of LOC/amnesia or symptoms of head injury in clear mental status is indicated. If the results of CT scan are normal, these patients may be safely discharged. But if there is no history of LOC/amnesia or symtoms of head injury in normal mental status, an immediate CT scan is not indicated and these patients may also be safely discharged.