Patients who reattend after head injury: a high risk group

Abstract

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.

Delayed Presentation after Head Injury: Is a Computed Tomography Scan Necessary?

“…One study, however, would suggest that up to 5% of patients with these late findings will eventually need urgent neurosurgical intervention. 25 With these conflicting study results, an argument can be made that there is some merit in finding pathology in the patient with a delayed presentation following head trauma. Patients found to have an abnormality on CT may need hospitalization to detect early mental status decline should complications develop.…”

“…Seventeen percent of patients had an abnormality other than skull fracture on CT scan. 25 It is difficult to know whether the 17% rate of pathology found applies to a population with delayed presentation or applies only to those who receive an initial evaluation (without a CT) and then return due to worsening symptoms. It is possible that the group who waited to be seen had milder initial trauma, which is why they did not think it was worthwhile to come for medical evaluation immediately.…”

“…18 There have been reports since then of delayed posttraumatic intracranial hemorrhage. 19,20,22,23,25,26 Snoey and Levitt described three patients who developed delayed subdural hematomas, all of whom had previously had normal CT scans. 24 Other recent reports have identified cases with a significantly prolonged interval of minimal symptoms prior to deterioration from intracranial hemorrhage.…”

“…These patients were included because neither a negative evaluation nor a negative CT scan immediately following head trauma excludes the possibility that pathology was present or may develop. 24,25 The charts of patients who had received a prior ED evaluation were reviewed to ensure that the initial GCS was 15 and that the initial neurologic examination was listed as normal. Transferred patients were excluded.…”

Delayed Intracranial Complications After Concussion

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The diagnostic value of clinical and radiologic variables for these complications has been subject to recent, comprehensive studies and reviews. 9,16,25,26 Though, there is a lack of information about the prevalence and time pattern of delayed, intracranial complications in MTBI patients as well as about the reliability of an early [27][28][29] CT scan without abnormalities with regard to any later deterioration. 6,18,24,26,30 Available data indicate that delayed complications are rare in patients with an ordinary brain concussion, i.e.…”