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Assessment of mortality associated with mild head injury in the pediatric age group
I S Keskil1, M K Baykaner, N Ceviker
1Department of Neurosurgery, Gazi University Medical School, Bşevler, Ankara, Turkey.
Insights
Mild head injury patients require careful monitoring. Computed tomographic scanning is the only reliable method to identify high-risk patients and reduce mortality.
Area of Science:
- Neurosurgery
- Trauma Care
- Emergency Medicine
Background:
- Reducing mortality in trauma patients necessitates vigilant monitoring, even for those initially assessed as low-risk.
- Head-injured patients admitted to the Neurosurgery Department of Gazi University Medical School between 1979 and 1992 were analyzed.
- A subset of children with mild head injury (Glasgow Coma Scale score of 15) experienced unfavorable outcomes.
Purpose of the Study:
- To identify clinical features distinguishing genuinely endangered patients among those with seemingly mild head trauma.
- To improve the identification of patients at higher risk than initially apparent.
Main Methods:
- Retrospective analysis of nearly 1600 hospitalized head-injured patients.
- Evaluation of clinical signs including post-traumatic amnesia, somnolence, irritability, anisocoria, local head trauma, associated injuries, altered consciousness history, and skull fracture.
- Comparison of clinical findings with patient outcomes.
Main Results:
- No specific clinical features reliably identified patients with mild head injury who were at risk of unfavorable outcomes.
- Three pediatric patients with initial Glasgow Coma Scale scores of 15 experienced adverse outcomes despite a mild injury classification.
Conclusions:
- Clinical assessment alone is insufficient to reliably identify all patients with mild head injury who are at risk.
- Computed tomographic (CT) scanning is the sole reliable diagnostic tool for identifying higher-risk patients.
- Implementing routine CT scanning for mild head injury cases can reduce avoidable mortality and morbidity.
Abstract:
Reducing mortality among accident and trauma patients requires careful attention to monitoring those regarded as being at low risk. We hospitalized almost 1600 head-injured patients in the period between 1979 and 1992 at the Neurosurgery Department of Gazi University Medical School, Ankara, Turkey. These patients were selected from among the numerous patients admitted to our emergency unit and treated with the same protocol in the same department. Among the hospitalized children, there were three patients defined as having a mild head injury on the basis of Glasgow Coma Scale scores of 15 who later had unfavorable outcomes. Clinical signs that might identify potentially endangered patients with mild injury were gathered; these included the presence of post-traumatic amnesia, somnolence, irritability, anisocoria, local evidence of trauma to the head, associated injuries, history of altered consciousness, and skull fracture. The study was designed to identify features by which patients who are in real danger can be distinguished among the many with trivial trauma that we face every day. We did not find any identifying clinical features and concluded that computed tomographic scanning is the only reliable answer. This will reduce avoidable mortality and morbidity by identifying the patients who are at higher risk than is at first evident.