The Galasko report implemented: the role of emergency medicine in the management of head injuries.
BACKGROUND
The objectives were to demonstrate the extra workload for emergency medicine of inpatient management of mild/moderate head injuries and to determine the effectiveness of current computed tomography guidelines.


METHODS
A retrospective study of head injuries presenting to St James's Hospital Dublin, where the Galasko report has been implemented since 2001. We studied injuries presented from January 2001 to January 2002. Length of stay, mechanism of injury, follow-up, indication for admission and computed tomography scan were identified.


RESULTS
A total of 2281 patients presented with head injury as their first or second triage complaint. One hundred and twenty-three patients were admitted to the emergency ward, of which 34 had computed tomography investigation. Ten computed tomography scans demonstrated intracranial injury. Intracranial injury was associated with vomiting, Glasgow coma score 14 (confusion), deterioration of Glasgow coma score, clinical basilar skull fracture and alcohol-related falls. The average length of stay for patients admitted to observation ward was 2.3 days and 5 days for those who had a brain injury on computed tomography scan.


CONCLUSIONS
Implementation of the Galasko report has resource, manpower and training implications for emergency medicine. The current computed tomography guidelines should be modified to include Glasgow coma score<15 and neurological symptoms for example, vomiting and alcohol-related falls.
Johnston
Jeremy J E
JJ
St James's University Hospital Dublin, UK. jeremyjohnston@doctors.org.uk
D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D004635:Emergency Medicine / Q000458:organization & administration* / Q000592:standards; D006752:Hospital Planning; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D007494:Ireland; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014055:Tomography, Emission-Computed / Q000706:statistics & numerical data