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Related Experiment Videos

Moderate head injury: a guide to initial management.

S C Stein1, S E Ross

  • 1Division of Neurosurgery, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden.

Journal of Neurosurgery
|October 1, 1992
PubMed
Summary

Patients with moderate head injuries, including those with an initial Glasgow Coma Scale (GCS) score of 13, require urgent hospital admission and CT scans. Intracranial lesions necessitate neurosurgical consultation and critical care, with serial scans for monitoring progression.

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Area of Science:

  • Neurosurgery
  • Emergency Medicine
  • Radiology

Background:

  • Moderate head injuries are clinically challenging to assess upon initial evaluation.
  • Glasgow Coma Scale (GCS) scores are crucial for initial injury grading.
  • The optimal initial management strategy for moderate head injuries requires further definition.

Purpose of the Study:

  • To determine the appropriate initial treatment and diagnostic workup for patients with moderate head injuries.
  • To evaluate the utility of cranial computerized tomography (CT) in identifying intracranial lesions in this patient group.
  • To assess the need for neurosurgical intervention and critical care admission based on initial findings.

Main Methods:

  • Retrospective review of 341 patients with GCS scores of 9-12 and 106 patients with GCS scores of 13.

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  • All patients underwent cranial computerized tomography (CT) upon admission.
  • Analysis of CT findings, neurosurgical interventions, and patient outcomes.

    • Main Results:

    • Abnormal CT scans were observed in 40.3% of patients, with 30.6% showing intracranial lesions.
    • 8.1% of patients required neurosurgical intervention, including craniotomies and intracranial pressure monitor insertion.
    • A GCS score of 13 was associated with a similar incidence of intracranial lesions as lower GCS scores, suggesting its inclusion in the moderate head injury category.
    • Skull fractures were poor predictors of intracranial abnormalities.
    • Serial CT scans revealed progression of radiological abnormalities in 32% of patients requiring repeat scans.

    Conclusions:

    • Patients with moderate head injuries, defined by initial GCS scores of 9-13, should be admitted and undergo urgent CT scanning.
    • Intracranial lesions identified on CT mandate immediate neurosurgical consultation, potential surgery, and critical care admission.
    • Serial CT scanning is essential for patients with unexpected recovery or clinical deterioration to detect evolving intracranial pathology.