Minor Head Injuries: One Year Experience According to the New Italian Guideline |
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Authors: | L Viola D Zotta V Martino R Barbato G Schisano |
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Institution: | (1) Department of Neurosurgery, Nuovo Pellegrini Hospital, ASL Naples 1, Italy, IT |
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Abstract: | Summary
Background. The data concerning a consecutive series of 4,536 adult patients suffering from minor head injuries treated at the Department
of Neurosurgery over a period of one year are reported.
Method. The patients' age, sex and the circumstances of the injury have been taken into consideration. The patients, according to
the new method, were divided into four groups.
Group 0 (3,864 patients) included all patients with Glasgow Coma Scale (GCS) score 15. They did not present any clinical
features such as loss of consciousness (LOC), post-traumatic amnesia (PTA), headache or vomiting. No risk factors (RF) such
as coagulopaties, alcoholism, drug abuse, epilepsy, previous neurological treatment or disabled elderly patients were detected.
Group 1 (600 patients) included patients with GCS score 15. The patients presented one or more clinical features (LOC, PTA,
headache, vomiting). No RF were presented.
Group 2 (24 patients) included patients with GCS score 14 with or without clinical features (LOC, PTA, headache, vomiting)
and with or without RF.
Group 0-1R (48 patients) included patients with GCS score 15 with or without clinical features (LOC, PTA, headache, vomiting).
All of them presented RF.
The presence of focal neurological signs, open injury and GCS score≦13 were considered criteria for exclusion.
Findings. All the patients from groups 1, 0-1R, 2 and 187 patients from group 0 underwent CT scan for a total of 859 exams which are
analyzed and discussed. 458 patients were admitted and are divided as follows: 216 from group 0, 192 from group 1, 26 from
group 0-1R and all the 24 belonging to group 2. Six patients were treated surgically (3 extradural haematomas, 2 lobe contusions,
1 acute subdural haematoma) and one of them (0.02% of the total) died (extradural haematoma). The patients who were not admitted
were sent home with an information sheet after at least a six hour observation period.
Interpretation. The authors draw the conclusion that they have evaluated the applicability and efficacy of guidelines, developed by the study
group on head injury of the Italian Society of Neurosurgery 19]. A critical part of our guidelines is not only to identify
all the intracranial lesions, but to identify patients harbouring relevant intracranial mass before clinical deterioration. |
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Keywords: | : Italian guideline mild head injury Glasgow Coma Scale score |
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