MANAGEMENT OF MINOR HEAD-INJURIES IN THE ACCIDENT AND EMERGENCY DEPARTMENT - THE EFFECT OF AN OBSERVATION WARD

The management of 483 patients presenting with minor head injury to th e accident and emergency (A&E) departments of two Scottish hospitals w as studied prospectively. Such patients comprised 5.7 and 3.9% of the total attendances to each department. Of the 277 patients assessed in the former department, 83 (30%) fulfilled at least one of the currentl y accepted criteria for recommending admission to hospital and 49 (17. 7%) patients were actually admitted. Patients in whom head injury was not the principal reason for admission were excluded from the study. I n the same time period the second department dealt with 206 patients w ith minor head injury, 49 (24%) of whom had criteria for admission. Ho wever, significantly fewer, 10 (4.9%) patients, were actually admitted . The major relevant factor when comparing the two departments was the existence in the former of an observation ward. These results support the view that easy access to hospital beds in a major determinant of management in patients presenting with minor head injury to the A&E de partment and may be more influential than clinical findings.