Which type of observation for patients with high-risk mild head injury and negative computed tomography?
OBJECTIVE
Current guidelines suggest hospital admission followed by home monitoring for high-risk patients with mild head injury and negative computed tomography scan. We tested early home monitoring under the care of a competent observer.


METHODS
A total of 1480 patients with mild head injury and negative computed tomography scan were prospectively studied. Based on clinical status and available home caretakers, patients were managed by in-hospital observation (n = 646) or early home monitoring (n = 834). Outcome measures were: (1) the detection of previously undiagnosed post-traumatic intracranial injury; (2) neurosurgical intervention; and (3) unfavourable outcome (death, permanent vegetative state or severe disability).


RESULTS
In the in-hospital arm, nine cases (1.4%) developed intracranial injuries (in three after discharge). In the early home-monitoring arm, six patients (0.7%) had a previously undiagnosed lesion after re-admission (P = 0.773 versus in-hospital arm). No patients with previously undiagnosed intracranial injuries had a neurosurgical intervention. After 6 months, five patients had died in the home monitoring arm (0.8%) versus eight (1.0%) in the in-hospital arm (P=0.785). No permanent disability or vegetative state was observed.


CONCLUSIONS
Early home monitoring may be safely proposed to selected "high-risk" patients, with an early negative computed tomography scan, normal clinical examination and feasible home monitoring.
Fabbri
Andrea
A
Dipartimento Emergenza-Urgenza Accettazione, Ospedale G.B. Morgagni, Azienda Unità Sanitaria Locale di Forlì, Forli, Italy. andfabbri@libero.it
Servadei
Franco
F
Marchesini
Giulio
G
Dente
Massimo
M
Iervese
Tiziana
T
Spada
Marco
M
Vandelli
Alberto
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D019370:Observation / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed