THE ROLE OF COMPUTERIZED-TOMOGRAPHY IN THE MANAGEMENT OF MILD HEAD-INJURY PATIENTS

We reviewed all cranial CT scans at our Neuroradiological Service requested by the Emergency Room from August 1993 to April 1994 and we noted that 41% of them dealt with patients admitted for closed head injuries. A retrospective study of 300 head injured patients who underwent CT examination on admission was performed CT scans were negative in 92% of cases. All patients with a normal neurological examination at the Emergency Room were regarded as mild head injury patients. This group comprised 79% of all the observations; intracranial lesions were disclosed by CT scans in 2% of them; whereas, in patients with neurological signs, CT scans demonstrated intracranial lesions in 17% of cases. We observed intracranial lesions more frequently in patients over 50 years, or in road accident head injury patients, or in parietal head injury patients and in patients who developed amnesia or episodes of vomiting following trauma. No relation was found between loss of consciousness and positive CT scans. On the basis of their experience and a review of the literature, we propose some guidelines for the management of mild head injury patients. All patients with a negative neurological examination should undergo 6-12 hours of clinical observation; after this period they might be simply discharged if there are no clinical changes. However, if the evaluation is threatened because the patient is intoxicated or uncooperative, then a CT scan is mandatory. Patients with a high risk disease such as coagulation defects or patients with a suspected cranial fracture should immediately undergo CT scans. If the patient's clinical status deteriorates during clinical observation, then CT scans should be performed before dismissal. We should bear in mind that a negative CT at an early stage does not completely rule out delayed complications. In conclusion the clinical observation is the mainstay in the management of mild head injuries.