Relative risk of deterioration after mild closed head injury

Abstract

In this prospective study, a series of 1812 consecutive mild head injured adult patients who visited the hospital emergency department were assessed. Twenty-eight patients (1.5%) deteriorated after head injury; 23 of these (1.3% of the series) required surgical intervention. Five patients (0.3%) deteriorated due to non-surgical causes [post-traumatic seizure 2, syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 3]. Most of the deterioration occurred within the first 24 hours (57%). Post-traumatic headache was found in 280 patients (15.5%) and 84 patients (4.6%) suffered post-traumatic vomiting. The relative risk is calculated. Age over 60, presence of drowsiness, focal motor weakness, post-traumatic headache and vomiting has increased risk of deterioration (p < 0.001). This study suggests that post-traumatic headache and vomiting deserve more clinical attention rather than being considered as post-traumatic syndrome only.

Indications for Computed Tomography in Patients With Mild Head Injury

“…25) Many studies have reported increased risk of intracranial lesions in patients with head injury aged over 65 years 9,29) or over 60 years. 2,4,5,7,16,24,34) Aging is one risk factor, but it is unlikely that there is a specific age threshold above which the risk suddenly increases. 24) Analysis of our subjects aged over 65 years old found no significant difference in lesion frequency, but risk does seem to become higher at around 60 years.…”

Severe Symptomatic Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone From Mild Closed Head Trauma and Concussion

“…This presented a quandary, initially resulting in misdiagnosis and improper treatment. The only other head-injury-related reports available in the literature describe patients sustaining head injury severe enough to cause skull fractures, intracranial hematomas, subarachnoid hemorrhages, and/or Glascow coma scale scores of < 12 [7][8][9][10]. Our patient had none of these findings, and without severe head injury, SIADH was not initially considered as a cause of his hyponatremia.…”

“…A 68-year-old female with closed head injury from a motor vehicle accident, having a skull fracture, subdural hematoma, subarachnoid hemorrhage and cerebral contusions, manifested SIADH with asymptomatic hyponatremia and without clinical deterioration [9]. In a study of 1,812 consecutive patients with mild closed head injury, only two developed hyponatremia, and both of these patients had documented intracranial hemorrhage [10]. In a similar study of 1,808 patients with head injury, 0.6% of 842 patients defined as having mild head injury, developed SIADH [11].…”

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“…9 Alguns autores sugerem, em casos de vômitos e cefaleia pós-TCE, a realização de TC e internação para observação, por provável lesão cerebral. 7,10 Nee et al 11 demonstraram que a presença de VPTCE aumenta em quatro vezes o risco de fratura de crânio em pacientes alertas, sem diferenças entre crianças e adultos. Outros autores defendem que o vômito como sintoma isolado não predispõe a riscos de lesão cerebral grave.…”

“…12 Apesar de todas as controvérsias, é consenso entre os autores que o número de episódios de vômito não aumenta a predisposição à lesão intracraniana, assim um simples episódio não seria mais importante que vários. 5,10,12 Os autores apresentam sua experiência com crianças, vítimas de traumatismo cranioencefálico leve, e discutem sobre a presença de vômitos e sua associação com o prognóstico do paciente. A presença de vômitos em pacientes com TCE leve em alguns serviços é um dos requisitos usados pelos médicos para indicação de TC.…”