Minor head injuries: One year experience according to the new Italian guideline

Background The data concerning a consecutive series of 4,536 adult patients suffering from minor head injuries treated at the Department of Neurosurge ry over a period of one year are reported. Method The patients' age, sex and the circumstances of the injury have been taken into consideration. The patients, according to the new method, were divided into four groups. Group 0 (3,864 patients) included all patients with Glasgow Coma Scale (GCS ) score 15. They did not present any clinical features such as loss of cons ciousness (LOC), post-traumatic amnesia (PTA), headache or vomiting. No ris k factors (RF) such as coagulopaties, alcoholism, drug abuse, epilepsy, pre vious neurological treatment or disabled elderly patients were detected. Group 1 (600 patients) included patients with GCS score 15. The patients pr esented one or more clinical features (LOC, PTA, headache, vomiting). No RF were presented. Group 2 (24 patients) included patients with GCS score 14 with or without c linical features (LOC, PTA, headache, vomiting) and with or without RF. Group 0-1R (48 patients) included patients with GCS score 15 with or withou t clinical features (LOC, PTA, headache, vomiting). All of them presented R F. The presence of focal neurological signs, open injury and GCS score less th an or equal to 13 were considered criteria for exclusion. Findings. All the patients from groups 1, 0-1R, 2 and 187 patients from gro up 0 underwent CT scan for a total of 859 exams which are analyzed and disc ussed. 458 patients were admitted and are divided as follows: 216 from grou p 0, 192 from group 1, 26 from group 0-1R and all the 24 belonging to group 2. Six patients were treated surgically (3 extradural haematomas, 2 lobe c ontusions, 1 acute subdural haematoma) and one of them (0.02% of the total) died (extradural haematoma). The patients who were not admitted were sent home with an information sheet after at least a six hour observation period . Interpretation. The authors draw the conclusion that they have evaluated th e applicability and efficacy of guidelines, developed by the study group on head injury of the Italian Society of Neurosurgery [19]. A critical parr o f our guidelines is not only to identify all the intracranial lesions, but to identify patients harbouring relevant intracranial mass before clinical deterioration.