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John T. Owings, MD; David H. Wisner, MD; Felix D. Battistella, MD; Jon Perlstein, MD; William F. Walby, MS; R. Steven Tharratt, MD

Arch Surg. 1998;133:941-946.

Objective  To determine if isolated transient loss of consciousness is an indicator of significant injury.

Setting  University-based level I trauma center.

Design and Patients  Phase 1 retrospective case series of all patients with trauma admitted directly from the emergency department to the operating room or an intensive care unit who had transient loss of consciousness as their only trauma triage criterion. Phase 2 prospective case series of all trauma patients transported by emergency medical system personnel with transient loss of consciousness as their only trauma triage criterion.

Main Outcome Measures  Emergency operation and intensive care unit admission.

Results  Phase 1: From January 1, 1992, to March 31, 1995, we admitted 10255 patients with trauma. Three hundred seven (3%) met the enrollment criteria and were admitted to the operating room (n=168) or intensive care unit (n=139). Of these, 58 (18.9%) were taken to the operating room emergently to manage life-threatening injuries: 11 (4%) had craniotomies and 47 (15%) had non-neurosurgical operations. Phase 2: From July 1 to December 31, 1996, 2770 trauma patients were transported to our facility; 135 (4.9%) met the enrollment criteria. Forty-one (30.4%) of these required admission, and 6 (4.4%) were taken emergently to the operating room from the emergency department (1 [1] for a craniotomy, 3 [2.2] for intra-abdominal bleeding, and 2 [1.5] for other procedures). Two (1.5%) of the 135 patients died.

Conclusions  Patients with isolated transient loss of consciousness are at significant risk of critical surgical and neurosurgical injuries. These patients should be triaged to trauma centers or hospitals with adequate imaging, surgical, and neurosurgical resources.

From the Departments of Surgery (Drs Owings, Wisner, and Battistella) and Medicine (Mr Walby and Dr Tharratt), University of California, Davis, Medical Center, Sacramento, and the Department of Surgery, David Grant Medical Center, Travis Air Force Base (Dr Perlstein), Calif.

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