A one - year cross-sectional observation study of the acute management of adult mild head injury in the Emergency Department Hospital Universiti Sains Malaysia

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Date
2001-11
Authors
Chan, Hiang Chuan
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Universiti Sains Malaysia
Abstract
Mild Head Injury (MHI) is one of the common presentation to Emergency Department. Most MHI patients recover fully but there is a significant proportion of them harbor intracranial hematoma that might deteriorate if the diagnosis is missed. The Neurological outcome of MHI patients are less favorable once deteriorated. The objectives of this study are; I) to assess whether clinical parameters are useful to predict the likelihood of intracranial injury, II) to determine the justification of selective use of cranial CT scans versus cranial CT for all MHI patients, Ill) to evaluate the differences between patients with GCS 13, 14 and 15, IV) ability to identify patients at risk before deterioration as neurological outcome are less favourable and V) to find out the incidence of missed intracranial injury in our current practice. 330 adult patients with initial Glasgow Coma Scale of 13-15 presented within 24 hours after blunt head trauma were collected from 1st January to 31st December 2000 at Hospital University Science Malaysia Emergency Department. For every patient, a standard questionnaires is used to document clinical parameters under study i.e. Loss of consciousness, moderate to severe headache, vomiting twice or more, Ear Nose and Throat bleed, skull fracture on plain radiograph, focal neurological deficit, post-traumatic seizure, mechanism of injury, alcohol or drug influences, significant past medical history and age > 60 years. Patient vital signs, systemic injury/injuries and other relevant factors are also noted. For those with cranial Computed Tomography scan done, the indication and finding (normal/abnormal) are documented. Each patient's modality of initial management is also determined. Patients who are admitted, especially those with no initial cranial CT done, will be followed up till discharge to detect any late deterioration including morbidity and mortality. Neurological charting, hemodynamic status and other relevant information in the ward are also noted. The data are analyzed using various descriptive studies. Chi-square analysis and Binary logistic regression are used to determine the significant of each clinical predictor in relation to cranial CT abnormality and mode of management. Level of significance is taken asp-value< 0.05. The result of this study is to highlight the awareness of the staff of Emergency Department and the in-patient team regarding which patients at higher risk of developing life-threatening intracranial injury in Mild Head Injury, which have different pathophysiology, severity and clinical outcome within this broad group. From this study, it was found that 1. Incidence of skull fracture on plain radiograph, 13.3o/o was relatively high. 2. There was 24.8o/o of abnormal cranial CT scan though only 31.8°/o of the sample underwent the investigation. Thus, 78.1 °/o of those with cranial CT scans done, had acute intracranial injury which need medical or neurosurgery intervention. 3. Skull fracture and persistent ENT bleed are the two risk factors that are strongly associated with abnormal cranial CT scan statistically. (with p<0.001 and 0.04 respectively). 4. LOC, headache, vomiting, maxillo~facial injury, unequal pupils, age> 60 years old, substance influence, amnesia and seizure are not statistically significant. 5. Percentage of obtaining abnormal cranial CT scan vary with GCS score; 62.5°/o, 74.2°/o and 89.7°/o of abnormal CT for GCS 15, 14 and 13 respectively. 6. Statistically, there is significant difference between GCS 13 and 15 of obtaining abnormal cranial CT with p < 0.02. 7. Patients with GCS 13 and 14 have higher chance of undergoing medical or neurosurgery intervention when compare to GCS 15 with both have p < 0.001. 8. 7 patients (2.1 o/o) deteriorated in the ward. 2 patients had no initial CT scan done. 6 out of 7 patients that deteriorated had GCS < 15. All the patients had one or more risk factors that are involved in the study. Based on the results of this study, the following guidelines have been proposed: 1. Current practice in regard to the use of plain skull radiograph in MHI should be continued. There is no practical way to diagnose skull fracture except radiologically. 2. Selective use of cranial CT scan for MHI is justified based on current standard of practice and to reduce escalating medical cost 3. Clinical parameters are useful to predict acute and delayed intracranial injury. Patients deemed at higher risk should have more closed neurological observation and even early cranial CT scan when indicated to prevent deterioration. 4. There is heterogeneity between patients with different GCS in MHI in term of pathophysiology, severity of injury and clinical outcome. Serious consideration must be given to the segregation of patients with GCS 13 and even 14 from those with GCS 15. 5. Patients with GCS 15 and GCS 14 without or with minimal symptoms can be observed at ED observation ward instead of admission.
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Mild Head Injury (MHI)
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