Morning Report: Minor Head Injury

Today’s Morning Report is presented by Dr. Osagie!

Minor Head Injury

Canadian Head CT Rule:

CT is only required for patients with minor head injury with any 1 of the following findings.

Patients with minor head injury who present with a Glasgow Coma Scale score of 13 to 15 after witnessed loss of consciousness, amnesia, or confusion.

-High Risk for Neurosurgical Intervention

Glasgow Coma Scale score lower than 15 at 2 hours after injury
Suspected open or depressed skull fracture
Any sign of basal skull fracture†
Two or more episodes of vomiting
65 years or older

-Medium Risk for Brain Injury Detection by Computed Tomographic Imaging

Amnesia before impact of 30 or more minutes
Dangerous mechanism‡

*The rule is not applicable if the patient did not experience a trauma, has a Glasgow Coma Scale score lower than 13, is younger than 16 years, is taking warfarin or has a bleeding disorder, or has an obvious open skull fracture.

†Signs of of basal skull fracture include hemotympanum, racoon eyes, cerebrospinal fluid, otorrhea or rhinorrhea, Battle’s sign.

‡Dangerous mechanism is a pedestrian struck by a motor vehicle, an occupant ejected from a motor vehicle, or a fall from an elevation of 3 or more feet or 5 stairs.

New Orleans Head CT Rule:

Computed tomography is required for patients with minor head injury with any 1 of the following findings.

The criteria apply only to patients who also have a Glasgow Coma Scale score of 15.

Headache
Vomiting
Older than 60 years
Drug or alcohol intoxication
Persistent anterograde amnesia (deficits in short-term memory)
Visible trauma above the clavicle
Seizure

Post Concussive Syndrome

Duration can last several weeks to up to 3 months
Common symptoms
- Headache – This is the most common symptom
- Cranial nerve symptoms and signs
- Psychological and neurovegetative problems
- Cognitive impairment
ED management –
- Patient education
- Set up follow up – A neurologist, physical medicine specialist, primary care physician, or psychologist specializing in these disorders usually coordinates treatment.

Sources:

Stiell I, Wells G, Vandemheen S, et al. “The Canadian CT Head Rule for patients with minor head injury” The Lancet. Volume 357, No. 9266, p1391–1396, 5 May 2001

Stiell I, Clement C, Rowe B et al. “Comparison of the Canadian CT Head Rule and the New Orleans Criteria in Patients With Minor Head Injury” JAMA. 2005;294 (12):1511-1518. doi:10.1001/jama.294.12.1511.