Abstract
The majority of patients presenting with mild head trauma will have no intracranial pathology and can be safely discharged home. It is estimated that 10% to 15% of these patients will have clinically significant findings on computed tomography imaging and up to 1% may require neurosurgical intervention. The revised Scandinavian Head Trauma Guidelines provide an evidence- and consensus-based algorithm to assist physicians in determining which patients presenting with minimal, mild or moderate blunt head injury are at higher risk for intracranial pathology and thus require neuroimaging and hospital admission. Striking a balance between health care costs and risk of morbidity remains an ongoing challenge and we will present our concerns with this useful, but conservative management algorithm.
Highlights
Main text and discussionThere are many similarities between the guidelines presented by Unden and colleagues and other well-validated computed tomography (CT) head guidelines, including the Canadian CT Head Rule and the New Orleans Criteria
It is estimated that 10% to 15% of this patient population will have intracranial pathology on CT and that fewer than 1% will require neurosurgical intervention
The need to identify these patients from the majority of patients that will have no intracranial pathology must be balanced against both health care costs and patient risk of exposure to ionizing radiation
Summary
Main text and discussionThere are many similarities between the guidelines presented by Unden and colleagues and other well-validated CT head guidelines, including the Canadian CT Head Rule and the New Orleans Criteria. * Correspondence: carolyn.benson@londonhospitals.ca Department of Clinical Neurological Sciences, London Health Sciences Center, University Campus, 339 Windermere Road, London ON, N6A 5A5, Canada conducted an extensive literature search and consensus panel to readdress the question of which patients require a CT head after minimal, mild or moderate head trauma and proposed an algorithm that will encompass most of these adult patients, including those on anticoagulation therapy. Both of these established guidelines have been shown to have 100% sensitivity for the need for neurosurgical intervention and high sensitivity for detecting clinically important brain injury, ranging from 87% to 100% for the Canadian CT Head Rule and 97% to 100% for the New Orleans Criteria [2,3,4].
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