Patients who reattend after head injury: a high risk group.
OBJECTIVE
To assess risk factors for important neurosurgical effects in patients who reattend after head injury.


METHODS
Retrospective study.


METHODS
606 patients who reattended a trauma unit after minor head injury.


METHODS
Intracranial abnormality detected on computed tomography or the need for neurosurgical intervention.


RESULTS
Five patients died: two from unrelated causes and three from raised intracranial pressure. On multiple regression analysis the only significant predictor for both abnormality on computed tomography (14.4% of reattenders) and the need for operation (5% of reattenders) was vault fracture seen on the skull radiograph (P < 10(-6)); predictors for abnormal computed tomogram were a Glasgow coma scale score < 15 at either first or second attendance (P < 0.0001) and convulsion at second attendance (P < 0.05); predictive for operation only was penetrating injury of the skull (P < 10(-6)). On contingency table analysis these associations were confirmed. In addition significant associations with both abnormality on computed tomography and operation were focal neurological abnormality, weakness, or speech disturbance. Amnesia or loss of consciousness at the time of initial injury, personality change, and seizures were significantly associated only with abnormality on computed tomography. Headache, dizziness, nausea, and vomiting were common in reattenders but were found to have no independent significance.


CONCLUSIONS
All patients who reattend after head injury should undergo computed tomography as at least 14% of scans can be expected to yield positive results. Where this facility is not available patients with predictors for operation should be urgently referred for neurosurgical opinion. Other patients can be readmitted and need referral only if symptoms persist despite symptomatic treatment or there is neurological deterioration while under observation. These patients are a high risk group and should be treated seriously.
Trauma Unit, Groote Schuur Hospital, Cape Town, South Africa.
M
M
Voss
J D
JD
Knottenbelt
M M
MM
Peden
D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000209:etiology; D006259:Craniocerebral Trauma / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012887:Skull Fractures / Q000150:complications / Q000000981:diagnostic imaging; D013019:South Africa; D014057:Tomography, X-Ray Computed