The role of neuroimaging in the initial management of patients with minor head injury

Ann Emerg Med. 1994 Jun;23(6):1279-83. doi: 10.1016/s0196-0644(94)70352-3.


Study objective: To determine whether omitting neuroimaging in the primary assessment of patients with minor head injuries in the emergency department is safe.

Design: Prospective cohort study.

Setting: University hospital, Copenhagen County Hospital, Glostrup, Denmark.

Participants: The study group consisted of 2,204 patients presenting to the ED after sustaining minor head injuries. Only patients able to talk and walk were included.

Measurements and main results: The decision to admit was based exclusively on clinical guidelines in which the findings in the ED were of highest priority. Seven patients (0.3%) had a skull radiograph; computed tomography was not used in the primary evaluation. Four hundred thirty patients (19.5%) were admitted. After hospitalization, four patients developed intracranial complications. One required surgery, two required hyperventilation, and one was observed. Follow-up demonstrated that no patient with an intracranial complication had been missed.

Conclusion: We found it safe to exclude neuroimaging in the primary assessment of patients with minor head injuries in the ED, and to rely instead on clinical criteria.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Clinical Protocols
  • Craniocerebral Trauma / classification
  • Craniocerebral Trauma / complications
  • Craniocerebral Trauma / diagnostic imaging*
  • Craniocerebral Trauma / epidemiology
  • Emergency Service, Hospital / standards*
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant, Newborn
  • Injury Severity Score
  • Male
  • Middle Aged
  • Patient Admission / statistics & numerical data*
  • Physical Examination / statistics & numerical data*
  • Prognosis
  • Prospective Studies
  • Tomography, X-Ray Computed / statistics & numerical data*