[Minor head injury in adults. Results of the application of a guideline].
BACKGROUND
Minor head injury (MHI) is one of the most frequent causes of emergency room admission which often requires expensive, and not always non-invasive, imaging techniques to be diagnosed correctly. It is therefore necessary to follow appropriate guidelines to improve the diagnosis and reduce the risk.


METHODS
A special guideline for the admission of MHI patients has been designed in agreement with other authors' reports and followed at the Emergency Department of S. Orsola-Malpighi Hospital (Bologna, Italy). The patients are classified into three groups based on the Glasgow Coma Scale (GCS) score, symptoms, clinical signs and relative medical histories. By group, the patients are then discharged, submitted to brain CT or to a short observation period. Our group 0 included the patients with GCS 15, no symptoms or risk factors and the possibility of being monitored at home. Such patients were treated and then discharged after receiving a sheet with the appropriate recommendations. Group 1 included the patients with GCS 15 and even a single symptom. Group 2 included the patients with GCS 14. All the patients in groups 1 and 2 were submitted to CT within 6 hours, as well as all the patients exhibiting any risk factors.


RESULTS
Group 0 patients were not submitted to skull radiography which used to be the referral examination for CT. Thus, the number of skull radiographs was reduced about 6-fold while that of CT examinations increased by 50%, though remaining acceptable. Consequently costs have been cut down significantly, as well as the X-ray dose to the patients' thyroid, while the rate of correct diagnoses has actually increased, more lesions being detected.


CONCLUSIONS
We believe it is rather useless, expensive and dangerous to perform skull radiography in adult MHI patients. Applying an appropriate guideline is the right way to make the correct diagnosis, lower costs and minimize X-ray exposure.
Servizio di Radiologia d'Urgenza Azienda Policlinico S. Orsola, Malpighi, Bologna.
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Ciccarese
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Milletti
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Venturoli
D000328:Adult; D003365:Costs and Cost Analysis; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000191:economics; D006801:Humans; D011859:Radiography