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Guidelines for the Management of Minor Head Injury in Adults . Società Italiana di Medicina di Emergenza-Urgenza (SIMEU) Study Group for SIMEU Guidelines. Torino, May 2000. Società Italiana di Medicina di Urgenza ed Emergenza (SIMEU) Study Group for SIMEU guidelines.

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Guidelines for the Management of Minor Head Injury in Adults


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guidelines for the management of minor head injury in adults

Guidelines for the Management ofMinor Head Injury in Adults

Società Italiana di Medicina di Emergenza-Urgenza (SIMEU)

Study Group for SIMEU Guidelines

Torino, May 2000

slide2

Società Italiana di Medicina di Urgenza ed Emergenza (SIMEU)

Study Group for SIMEU guidelines

Ivo CasagrandaDaniele CoenPaolo DemattéVittorio DemicheliCarlo LocatelliFranco PerraroMassimo Pesenti-CampagnoniFernando PorroGiuseppe Re

Torino, May 2000

slide3

Minor Head InjuryEpidemiology

  • 300 - 400 admissions / every year/ 100.000 inhabitants
  • 10% severe head injury
  • 10% moderate head injury
  • 80% minor head injury
    • 1-3% intracranial hematoma development
slide4

Minor Head InjuryDefinition

  • All people with head injury that arrive in Emmergency Department with a GCS Score of 15 or 14.
  • With the exception of:
    • Focal neurological deficits
    • Depressed skull fracture
    • Clinical signs of basal skull fracture
slide5

Minor Head InjuryClassification

Group 0 pain limited to the impact zone, dizziness

Group 1 brief loss of consciousness post-traumatic amnesia worsening headache vomiting

Group 2 GCS 14

slide6

Minor Head InjuryRisk Factors

  • alcoholism
  • Coagulopathies
  • Previous neurosurgery
  • Drug use
  • epilepsy
  • Old age
slide7

Minor Head InjuryQuestions to be answered

  • What is the sensitivity and the specificity of

clinical examination ?

  • Should all patients who arrive in ED with a GCS Score of 15 and brief loss of consciousness undergo a CT scan?
  • Does x-ray still play a role?
  • What is the procedure if the CT scan results negative?
slide8

Minor Head InjuryManagement

Grouprecommendationslevel of

evidence

0 - clinical assessment B

- radiological examination is not B

necessary

- can be discharged with an information C

sheet

slide9

Minor Head InjuryManagement

grouprecommendationslevel of

evidence

0 with added - observation for at least 24 hours C

risk factors - CT scanning should be taken into C

consideration

slide10

Minor Head InjuryManagement

grouprecommeandationlevel of

evidence

1 - observation for at least 6 hours C

- perform a skull CT scan as soon as possible B

- skull x-ray is not indicated B

slide11

Minor head InjuryManagement

grouprecommendationlevel of

evidence

1 - skull x-ray if CT scan not available B

- if a fracture is found perform a CT scan B

- CT should be carried out in an istitution with

a neurosurgery ward C

slide12

Minor Head injuryManagement

grouprecommendationlevel of

evidence

1 with added - observation for at least 24 hours C

risk factors - perform a CT scan B

- cogulopathic patients should repeat CT C

scan before discharge

slide13

Minor Head InjuryManagement

grouprecommendationlevel of

evidence

2 - perform a CT scan B

- keep under continous observation C

and discharge when proven to be

neurologically intact

slide14

Minor Head InjurySensibilityandspecificityofneurologicalexamination

  • Negative neurological examination does not exclude intracranial lesions
  • CT scan detects intracranial lesions in 3 – 17% of patients

with a GCS Score of 15

  • Neurosurgical intervention in 0 - 3 % of patients
slide15

Minor Head InjuryRole of skull x-ray

  • If CT scan is not available
  • CT scan must be done with

bone-windows

slide16

Minor Head InjuryRole of skull CT scan

  • All good quality literature recommends performjng a CT scan in patients with a GCS score of 15 and loss of consciousness
  • Even if the CT scan is negative the patient should be discharged with written advice for home observation