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Five patients died:two from unrelated causes and three from raised intracranial pressure.On multiple regression analysis,the only significant predictor for both abnormality on computed tomography(14.4%of reattenders) and the need for operation(5%of reattenders)was vault fracture seen on the skull radiograph(P<10-6);predictors for abnormal computed tomogram were a Glasgow coma score less than 15 at either first or second attendance(P<0. 0001)and convulsion at second attendance(P<0.05);predictive for operation only was penetrating injury of the skull(P<10.6).On contingency table analysis,these associations were confirmed.In addition,significant associations with both abnormality on computed tomography and operation were focal neurological abnormality,weakness,or speech disturbance.Amnesia or loss of consciousness at the time of initial injury,personality change and seizures were significantly associated only with abnormality on computed tomography.Headache,dizziness,nausea and vomiting were common in reattenders but were found to have no independent significance.All patients who reattend after head injury should undergo computed tomography as at least 14%of scans can be expected to yield positive results.Where this facility is not available,patients with predictors for operation should be urgently referred for neurosurgical opinion.Other patients can be readmitted and need referral only if symptoms persist despite symptomatic treatment or there is neurological deterioration while under observation.These patients are a high risk group and should be treated seriously. |
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abscess,intracranial
CAT scan
CAT scan,abnormal
CAT scan,indications for
emergencies,neurologic
head injury
head injury,delayed deterioration following
head injury,evaluation of
head injury,management of
head injury,mild
head injury,return to hospital following
hematoma,epidural-cranial
hematoma,intracerebral
risk factors
skull fracture
subdural hematoma
treatment of neurologic disorder
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