[Scandinavian guidelines for management of minimal, mild and moderate head injuries]

The Scandinavian Neurotrauma Committee (SNC) was initiated by the Scandinavian Neurosurgical Society to develop evidence-based guidelines for improved care of neurotrauma patients. A MEDLINE search identified 475 papers dealing with the management of minimal, mild and moderate head injuries. Fourty-two studies presenting Class II evidence on the initial management of such injuries were reviewed and management guidelines were developed. Implementation of the Head Injury Severity Scale is advocated. Patients with minimal injuries (no loss of consciousness (LOC), Glasgow Coma Scale (GCS) score 15) can be safely discharged. Routine early CT scan is recommended in cases with mild injuries (history of LOC, GCS 14-15) and patients with normal scans may be discharged. CT scan and admission is mandatory in moderate injuries (GCS < or = 13). All patients harbouring additional risk factors should be scanned and admitted. A flow chart for clinical decision making and a Head Injury Instruction card are introduced.