Minor head injuries: one year experience according to the new Italian guideline.

BACKGROUND

The data concerning a consecutive series of 4,536 adult patients suffering from minor head injuries treated at the Department of Neurosurgery over a period of one year are reported.

METHOD

The patients' age, sex and the circumstances of the injury have been taken into consideration. The patients, according to the new method, were divided into four groups. Group 0 (3,864 patients) included all patients with Glasgow Coma Scale (GCS) score 15. They did not present any clinical features such as loss of consciousness (LOC), post-traumatic amnesia (PTA), headache or vomiting. No risk factors (RF) such as coagulopaties, alcoholism, drug abuse, epilepsy, previous neurological treatment or disabled elderly patients were detected. Group 1 (600 patients) included patients with GCS score 15. The patients presented one or more clinical features (LOC, PTA, headache, vomiting). No RF were presented. Group 2 (24 patients) included patients with GCS score 14 with or without clinical features (LOC, PTA, headache, vomiting) and with or without RF. Group 0-1R (48 patients) included patients with GCS score 15 with or without clinical features (LOC, PTA, headache, vomiting). All of them presented RF. The presence of focal neurological signs, open injury and GCS score < or = 13 were considered criteria for exclusion.

FINDINGS

All the patients from groups 1, 0-1R, 2 and 187 patients from group 0 underwent CT scan for a total of 859 exams which are analyzed and discussed. 458 patients were admitted and are divided as follows: 216 from group 0, 192 from group 1, 26 from group 0-1R and all the 24 belonging to group 2. Six patients were treated surgically (3 extradural haematomas, 2 lobe contusions, 1 acute subdural haematoma) and one of them (0.02% of the total) died (extradural haematoma). The patients who were not admitted were sent home with an information sheet after at least a six hour observation period.

INTERPRETATION

The authors draw the conclusion that they have evaluated the applicability and efficacy of guidelines, developed by the study group on head injury of the Italian Society of Neurosurgery. A critical part of our guidelines is not only to identify all the intracranial lesions, but to identify patients harbouring relevant intracranial mass before clinical deterioration.