Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

OBJECTIVE: To assess risk factors for important neurosurgical effects in patients who reattend after head injury. DESIGN: Retrospective study. SUBJECTS: 606 patients who reattended a trauma unit after minor head injury. MAIN OUTCOME MEASURES: Intracranial abnormality detected on computed tomography or the need for neurosurgical intervention. RESULTS: Five patients died: two from unrelated causes and three from raised intracranial pressure. On multiple regression analysis the only significant predictor for both abnormality on computed tomography (14.4% of reattenders) and the need for operation (5% of reattenders) was vault fracture 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 skull (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 abnormality, weakness, or speech disturbance. Amnesia or loss of consciousness at the time of initial injury, personality change, and seizures were significantly associated only with abnormality on computed tomography. Headache, dizziness, nausea, and vomiting were common in reattenders but were found to have no independent significance. CONCLUSIONS: All patients who reattend after head injury should undergo computed tomography as at least 14% of scans can be expected to yield positive results. Where this facility is not available patients with predictors for operation should be urgently referred for neurosurgical opinion. Other patients can be readmitted and need referral only if symptoms persist despite symptomatic treatment or there is neurological deterioration while under observation. These patients are a high risk group and should be treated seriously.

Type

Journal article

Journal

BMJ

Publication Date

25/11/1995

Volume

311

Pages

1395 - 1398

Keywords

Adult, Brain Injuries, Craniocerebral Trauma, Female, Hospitalization, Humans, Male, Patient Acceptance of Health Care, Patient Readmission, Retrospective Studies, Risk Factors, Skull Fractures, South Africa, Tomography, X-Ray Computed