Which type of observation for patients with high-risk mild head injury and negative computed tomography?

Eur J Emerg Med. 2004 Apr;11(2):65-9. doi: 10.1097/00063110-200404000-00002.

Abstract

Objective: Current guidelines suggest hospital admission followed by home monitoring for high-risk patients with mild head injury and negative computed tomography scan. We tested early home monitoring under the care of a competent observer.

Methods: A total of 1480 patients with mild head injury and negative computed tomography scan were prospectively studied. Based on clinical status and available home caretakers, patients were managed by in-hospital observation (n = 646) or early home monitoring (n = 834). Outcome measures were: (1) the detection of previously undiagnosed post-traumatic intracranial injury; (2) neurosurgical intervention; and (3) unfavourable outcome (death, permanent vegetative state or severe disability).

Results: In the in-hospital arm, nine cases (1.4%) developed intracranial injuries (in three after discharge). In the early home-monitoring arm, six patients (0.7%) had a previously undiagnosed lesion after re-admission (P = 0.773 versus in-hospital arm). No patients with previously undiagnosed intracranial injuries had a neurosurgical intervention. After 6 months, five patients had died in the home monitoring arm (0.8%) versus eight (1.0%) in the in-hospital arm (P=0.785). No permanent disability or vegetative state was observed.

Conclusion: Early home monitoring may be safely proposed to selected "high-risk" patients, with an early negative computed tomography scan, normal clinical examination and feasible home monitoring.

Publication types

  • Editorial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Craniocerebral Trauma / diagnosis*
  • Craniocerebral Trauma / diagnostic imaging
  • Home Care Services*
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods*
  • Observation / methods*
  • Prospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed