Late presentations of minor head injury

Barrow, Anna; Ndikum, John; Harris, Tim

doi:10.1136/emermed-2011-200523

Cited by 10 publications

(21 citation statements)

References 26 publications

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“…There are few studies that even estimate the size of this population. One study found that approximately a third of a cohort of patients presenting after 4 h of injury presented after 24 h 11. In contrast, an older study found only 6.7% of ED patients with head injury to present after 12 h of injury 13…”

Section: Introductionmentioning

confidence: 99%

“…A single study has found that comparable risk factors to those present in NICE guidelines are predictive of traumatic CT abnormalities in patients with head injury presenting after 4 h of injury 11. However, how well the guidelines identify injuries in patients presenting after 24 h, a group where the CCHR has not been validated, has not been assessed.…”

Section: Introductionmentioning

confidence: 99%

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CT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

2016

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

CT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

2016

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“…Not all patients present to the ED immediately after sustaining a head injury, particularly if they fall into the minor/mild head injury group. Some present after 24 h [ 10 ]. The paucity of research in this area means that estimating the size of this population is difficult.…”

Section: Introductionmentioning

confidence: 99%

The risk of intra-cranial haemorrhage in those presenting late to the ED following a head injury: a systematic review

2015

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BackgroundHead injury represents an extremely common presentation to emergency departments (ED), but not all patients present immediately after injury. There is evidence that clinical deterioration following head injury will usually occur within 24 h. It is unclear whether this means that head injury patients that present in a delayed manner, especially after 24 h, have a lower prevalence of significant traumatic injuries including intra-cranial haemorrhages.MethodsA systematic review protocol was designed with the aim of systematically identifying and evaluating studies in delayed ED presentation head injury populations in order to establish whether the prevalence of significant intra-cranial injury was affected by delay in presentation. Two independent researchers assessed retrieved studies for inclusion against pre-determined inclusion criteria. Studies had to be conducted in ED head injury populations presenting in a delayed manner, and report a measure of prevalence of traumatic CT abnormality as an outcome.ResultsThree studies were eligible for inclusion. They were all of poor methodological quality, and heterogeneity prevented meta-analysis. The reported prevalence of traumatic intra-cranial injury on CT was between 2.2 and 6.3 %. This is generally lower than reported in the literature for non-delayed presentation head injury populations.ConclusionsAvailable evidence suggests that head injury patients who present in a delayed fashion to the ED may have lower rates of intra-cranial injury compared to non-delayed head injury patients. However, the evidence is sparse and it is of too low quality to guide clinical practice. Further research is required to help the clinical risk assessment of this group.Trial registrationPROSPERO: CRD42015016135

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“…Past research results suggest intoxication-related trauma is associated with higher rates of traumatic brain injury, morbidity, mortality, 1 – 6 and computed tomography (CT) and magnetic resonance (MR) imaging utilization. 9 – 10 However, few studies have focused on the relationship between delayed time-from-injury to presentation to the ED, 11 intoxication and skeletal fracture locations, 12 mechanism of injury leading to fracture, 12 or accuracy of initial radiographic interpretations by nonradiologists. 13 …”

Section: Introductionmentioning

confidence: 99%

Radiology of Fractures in Intoxicated Emergency Department Patients

et al. 2015

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The purpose of this study was to investigate the relationship of alcohol intoxication to time-to-presentation following injury, fracture type, mechanism of injury leading to fracture, and initial diagnostic radiology interpretation performance of emergency physicians versus diagnostic radiologists in patients who present to the emergency department (ED) and are subsequently diagnosed with fracture.Medical records of 1286 patients who presented to the ED and were diagnosed with fracture who also underwent plain film or computed tomography (CT) imaging were retrospectively reviewed. The subjects were divided into intoxicated and sober groups. Patient characteristics, injury-to-presentation time, fracture location, and discrepancies between initial clinical and radiological evaluations were compared.Of 1286 subjects, 181 patients were included in the intoxicated group. Only intoxicated patients presented with head/neck fractures more than 24 hours after injury. The intoxicated group showed a higher rate of head/neck fractures (skull 23.2% vs 5.8%, face and orbit 30.4% vs 9.5%; P < 0.001) and a lower rate of extremity injuries. The rate of nondiagnosis of fractures by emergency physicians later identified by radiologists was the same in both groups (7.7% vs 7.7%, P = 0.984).While the same proportion of intoxicated patients presented more than 24 hours following injury, only intoxicated patients presented with craniofacial and cervical spinal fractures during this period. Alcohol-related injuries are more often associated with head/neck fractures but less extremity injuries. The rate of fractures missed by emergency physicians but later diagnosed by radiologists was the same in intoxicated and sober patients.

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Late presentations of minor head injury

Abstract: Patients with minor head injury who present over 4 h post-insult exhibit a similar risk of intracranial pathology to those presenting within 4 h. The risk factors previously identified to predict intracranial injury are similar in this study.

Cited by 10 publications

References 26 publications

CT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

CT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

The risk of intra-cranial haemorrhage in those presenting late to the ED following a head injury: a systematic review

Radiology of Fractures in Intoxicated Emergency Department Patients

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