Can patients with minor head injuries be safely discharged home?
P. A. Taheri, H. Karamanoukian, K. Gibbons, N. Waldman, R. J. Doerr and E. L. Hoover
Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112.
To identify all patients with serious intracranial injury, current
treatment strategies include admission and/or computed tomographic
evaluation of all patients with head injuries. However, the majority of
patients with head injuries who are awake do not require subsequent
intervention. A review of 407 consecutive patients with head injuries
treated at an adult regional trauma center identified 310 patients with
Glasgow Coma Scores of 15 in the emergency department, all of whom were
admitted. Five patients with Glasgow Coma Scores of 15 required
intervention for intracranial abnormality. All five patients had skull
fractures and/or neurologic deficits. Based on this and other studies,
criteria for discharge from the emergency department are a Glasgow Coma
Score of 15, no deficit except amnesia, no signs of intoxication, and no
evidence of basilar fracture on clinical examination or linear fracture on
screening skull roentgenography. Safe discharge without universal computed
tomographic evaluation or admission is possible and cost-efficient.
