Abstract
PurposeHead trauma is common in the emergency department. Identifying the few patients with serious injuries is time consuming and leads to many computerized tomographies (CTs). Reducing the number of CTs would reduce cost and radiation. The aim of this study was to evaluate the characteristics of adults with head trauma over a 1-year period to identify clinical features predicting intracranial hemorrhage.MethodsMedical record data have been collected retrospectively in adult patients with traumatic brain injury. A total of 1638 patients over a period of 384 days were reviewed, and 33 parameters were extracted. Patients with high-energy multitrauma managed with ATLS™ were excluded. The analysis was done with emphasis on patient history, clinical findings, and epidemiological traits. Logistic regression and descriptive statistics were applied.ResultsMedian age was 58 years (18–101, IQR 35–77). High age, minor head injury, new neurological deficits, and low trauma energy level correlated with intracranial hemorrhage. Patients younger than 59 years, without anticoagulation or antiplatelet therapy who suffered low-energy trauma, had no intracranial hemorrhages. The hemorrhage frequency in the entire cohort was 4.3% (70/1638). In subgroup taking anticoagulants, the frequency of intracranial hemorrhage was 8.6% (10/116), and in the platelet-inhibitor subgroup, it was 11.8% (20/169).ConclusionThis study demonstrates that patients younger than 59 years with low-energy head trauma, who were not on anticoagulants or platelet inhibitors could possibly be discharged based on patient history. Maybe, there is no need for as extensive medical examination as currently recommended. These findings merit further studies.
Highlights
During the twentieth century, patients with traumatic brain injury and loss of consciousness presenting in the emergency department were admitted for further observation
The study was conducted as a retrospective analysis of medical records of patients presenting with head trauma at the emergency department of Helsingborg General Hospital
Level of consciousness was classified according to the Scandinavian reaction level scale (RLS-85) in 1608 (98.2%) cases
Summary
Patients with traumatic brain injury and loss of consciousness presenting in the emergency department were admitted for further observation. If they deteriorated during observation, computerized tomography (CT) was performed. Modern guidelines for managing traumatic brain injury in the emergency room have been utilized for well over a decade and has alleviated. When these guidelines are applied correctly, approximately 50% of the patients undergo head CTs [1]. Repetitive CT of the head may be related to adverse effects later in life. Even though modern CT machines are using less and less radiation, X-ray-induced cancer is something the clinician must take into account [2,3,4,5]
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