Cognitive deficits in presumed minor head-injured patients

To determine the frequency of cognitive deficits in ED patients with presumed minor head injury and to identify factors in the initial history and physical examination predictive of cognitive deficits in these patients.

A prospective clinical study was performed over a nine-month period at a large community-based ED (60,000 patient annual census). Consecutive patients between 16 and 50 years of age who presented to the ED with a history of blunt trauma or a deceleration injury to the head and a Glasgow Coma Scale (GCS) score of 14 or 15 were included. Patients who were admitted to the hospital or who had an abnormal imaging study of the skull or brain also were excluded. Detailed history and physical examination findings were collected using a standardized data form. Cognitive testing was done at one week postinjury (Halstead-Reitan Neuropsychological Test Battery).

Seventy patients were originally entered into the study, and 36 completed the follow-up. Those completing the study were more commonly employed and less likely to have used sensorium-altering drugs or ethanol. Of the 36 patients who completed the study, 42% had either mild or moderate cognitive deficits at one week postinjury. Abnormal cerebellar function during the initial visit was associated with the presence of cognitive deficits at follow-up (p = 0.004). However, only four of 15 (27%; 95% CI 8-55%) patients with a cognitive deficit had an abnormal cerebellar finding.

Many patients with minor head injuries have cognitive deficits one week after injury. History and physical examination features are poor predictors of these deficits. Further studies are needed to evaluate the duration and final outcome of these cognitive deficits.