PATIENTS WHO REATTEND AFTER HEAD-INJURY - A HIGH-RISK GROUP

Objective-To assess risk factors for important neurosurgical effects i n patients who reattend after head injury. Design-Retrospective study. Subject -606 patients who reattended a trauma unit after minor head i njury. Main outcome measures-Intracranial abnormality detected on comp uted tomography or the need for neurosurgical intervention. Results-Fi ve patients died: two from unrelated causes and three from raised intr acranial pressure. On multiple regression analysis the only significan t predictor for both abnormality on computed tomography (14.4% of reat tenders) and the need for operation (5% of reattenders) was vault frac ture seen on the skull radiograph (P<10(-6)); predictors for abnormal computed tomogram were a Glasgow coma scale score <15 at either first or second attendance (P<0.0001) and convulsion at second attendance (P <0.05); predictive for operation only was penetrating injury of the sk ull (P<10(-6)). On contingency table analysis these associations were confirmed. In addition significant associations with both abnormality on computed tomography and operation were focal neurological abnormali ty, weakness, or speech disturbance. Amnesia or loss of consciousness at the time of initial injury, personality change, and seizures were s ignificantly associated only with abnormality on computed tomography. Headache, dizziness, nausea, and vomiting were common in reattenders b ut were found to have no independent significance. Conclusions-All pat ients who reattend after head injury should undergo computed tomograph y as at least 14% of scans can be expected to yield positive results. Where this facility is not available patients with predictors for oper ation should be urgently referred for neurosurgical opinion. Other pat ients can be readmitted and need referral only if symptoms persist des pite symptomatic treatment or there is neurological deterioration whil e under observation. These patients are a high risk group and should b e treated seriously.