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

Ivo Casagranda Daniele Coen Paolo Dematté Vittorio Demicheli Carlo Locatelli Franco Perraro Massimo Pesenti-Campagnoni Fernando Porro Giuseppe Re Società Italiana di Medicina di Urgenza ed Emergenza (SIMEU) Study Group for SIMEU guidelines Torino, May 2000

Ivo Casagranda, MD Minor Head Injury Epidemiology admissions / every year/ inhabitants 10% severe head injury 10% moderate head injury 80% minor head injury 1-3% intracranial hematoma development

Ivo Casagranda, MD Minor Head Injury Definition 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

Ivo Casagranda, MD Minor Head Injury Classification 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

Ivo Casagranda, MD Minor Head Injury Risk Factors alcoholism Coagulopathies Previous neurosurgery Drug use epilepsy Old age

Ivo Casagranda, MD Minor Head Injury Questions 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?

Ivo Casagranda, MD Group recommendations level of evidence 0 - clinical assessment B - radiological examination is not B necessary - can be discharged with an information C sheet Minor Head Injury Management

Ivo Casagranda, MD group recommendationslevel of evidence 0 with added - observation for at least 24 hoursC risk factors- CT scanning should be taken into C consideration Minor Head Injury Management

Ivo Casagranda, MD group recommeandation level of evidence 1 - observation for at least 6 hoursC - perform a skull CT scan as soon as possible B - skull x-ray is not indicated B Minor Head Injury Management

Ivo Casagranda, MD group recommendation level of evidence 1 - skull x-ray if CT scan not availableB - if a fracture is found perform a CT scan B - CT should be carried out in an istitution with a neurosurgery ward C Minor head Injury Management

Ivo Casagranda, MD group recommendation level of evidence 1 with added - observation for at least 24 hoursC risk factors- perform a CT scan B - cogulopathic patients should repeat CT C scan before discharge Minor Head injury Management

Ivo Casagranda, MD group recommendationlevel of evidence 2 - perform a CT scan B - keep under continous observationC and discharge when proven to be neurologically intact Minor Head Injury Management

Ivo Casagranda, MD 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 % of patients Minor Head Injury Sensibility and specificity of neurological examination

Ivo Casagranda, MD If CT scan is not available CT scan must be done with bone-windows Minor Head Injury Role of skull x-ray

Ivo Casagranda, MD 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 Minor Head Injury Role of skull CT scan