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Paul A. Taheri, MD; Hratch Karamanoukian, MD; Kevin Gibbons, MD; Neil Waldman; Ralph J. Doerr, MD; Eddie L. Hoover, MD

Arch Surg. 1993;128(3):289-292.

Abstract
• 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.

(Arch Surg. 1993;128:289-292)

Author Affiliations
From the Department of Surgery, Tulane University School of Medicine, New Orleans, La (Dr Taheri); and Departments of Surgery (Drs Karamanoukian, Doerr, and Hoover and Mr Waldman) and Neurosurgery (Dr Gibbons), The State University of New York at Buffalo.

Footnotes
Accepted for publication March 21, 1992.

Reprint requests to Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112 (Dr Taheri).

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