Minor head injury: predicting follow-up after discharge from the Emergency Department.
BACKGROUND
Up to 50% of ED patients discharged within a minor head injury (MHI) will develop postconcussive syndrome (PCS) within 1 month of injury. The follow-up visit is an important opportunity to identify and treat PCS before it becomes persistent.


OBJECTIVE
To identify factors predictive of follow-up (FU) after ED discharge in patients presenting with MHI.


METHODS
Prospective, observational study of a convenience sample of 71 MHI presenting within 24 hours of injury to the ED of a university teaching hospital between February 1996 and October 1997. MHI defined as loss of consciousness not greater than 10 minutes or amnesia, GCS 15, no skull fracture on PE, no new focality to neurologic exam and no brain injury on CT if one was done. Neurobehavioural test scores, clinical information and demographic data collected via use of standardized patient encounter form. All patients were discharged with written instructions to FU with their private physician within 1-2 weeks. Patients without a follow-up physician were assigned one. At 1 month post-injury, all patients were telephoned to determine if they had followed-up.


METHODS
Stepwise, multivariate, logistic regression.


RESULTS
Thirty one out of 71 (43.7%) reported FU with a physician within 1 month. Factors associated with FU were performance of a head CT in the ED (OR = 3.58, 95% CI = 1.12-11.37), associated laceration (OR = 8.84, 95% CI = 1.69-42.55), female gender (OR = 3.19, 95% CI = 1.04-9.82), and African-American race (OR = 0.36, 95% CI = 0.13-0.99).


CONCLUSIONS
Several factors predict FU after ED discharge for MHI. Patients unlikely to FU may benefit from an assessment of PCS risk before they leave the ED.
Bazarian
J
J
Department of Emergency Medicine, University of Rochester Medical Center, NY 14642, USA. jeff_bazarian@urmc.rochester.edu
Hartman
M
M
Delahunta
E
E
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology; D000368:Aged; D001924:Brain Concussion / Q000209:etiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors