Guidelines for minor head injured patients' management in adult age. The Study Group on Head Injury of the Italian Society for Neurosurgery.

The study group on Head Injury of the Italian Society for Neurosurgery suggests the following guidelines for minor head injured patients management. Patients either oriented to time, space and person (GCS 15) or confused (GCS 14) are included among the group of minor head injury. Criteria of exclusion are the presence of focal neurological deficits, open injury and a GCS < or = 13. Six categories of risk factors (coagulopathies, alcoholism, drug abuse, epilepsy, previous neurosurgical treatments and disabled elderly patients) relevant to the clinical course are identified. Three group of patients are distinguished. Patients in the Group 0 (GCS 15, without loss of consciousness, amnesia, diffuse headache, vomiting) could be sent home from Emergency Department after at least 6 hours period of observation with an information sheet. Patients in the Group 1 (GCS 15, with loss of consciousness and/or amnesia and/or diffuse headache and/or vomiting) require clinical observation (> or = 6 hours) and neuroradiological assessment. According to hospital availability, either skull-X rays or CT scan is obtained. In the presence of a skull fracture a CT scan is mandatory. In the presence of intracranial lesions, neurosurgical consultation is requested. In the absence of skull fractures or intracranial lesions the patient is admitted for observation (> or = 24 hours). Patients in the Group 0 and in the Group 1 with a risk factor (R) are admitted to the hospital (> or = 24 hours) and submitted to a CT scan. In patients with coagulopathies or in treatment with anticoagulants a CT scan should be repeated before discharge even in the absence of intracranial lesion on the first CT. In patients in the Group 2 (GCS 14) a CT scan is obtained in all cases independent of the presence of a risk factor.