MANAGEMENT OF LOW-RISK HEAD-INJURIES IN AN ENTIRE AREA - RESULTS OF AN 18-MONTH SURVEY

All patients admitted following a minor head injury (GCS is without ne urological deficits) during an 18 month period in an entire area were submitted to the same diagnostic and therapeutic protocol. Adult patie nts were x rayed and in the cases with skull fracture (even asymptomat ic), a computed tomographic (CT) scan was performed. Children (below t he age of 14) did not routinely receive skull X-rays but were admitted to one of the five regional hospitals where a CT scanner was availabl e 24 hours per day. Neuroradiologic investigations (carried out in ove r 600 patients) showed posttraumatic lesions in 201 cases; 113 of thes e patients were transferred to the neurosurgical center. There were 49 patients with extradural hematomas, 41 with brain contusions, 17 with depressed skull fractures, and six with subdural hematomas. Of these 113, 40 patients were operated on (mainly extradural hematomas); surgi cal indications were based on appearance of clinical deterioration, le sion volume, presence of midline, shift, and/or compressed third ventr icle and basal cisterns. In eight cases there was a clinical deteriora tion to a GCS of 13 or less, in all of these patients, the CT diagnosi s (and transfer to a neurosurgical center, preceded the onset of deter ioration. All patients admitted to such a center had a good outcome, b ut a survey of deaths related to head injury in the area revealed two fatalities following minor head injury. The only avoidable death was a patient with multiple brain contusions who developed sudden brain swe lling on day 12 posttrauma. We conclude that, even if management morta lity is not zero, our protocol is sufficiently safe for the treatment of minor head injury.