1. Kayyali, Andrea MSN, RN

Article Content

According to this study:


* Outcomes were comparable in both groups after three months.



No universal guidelines exist for the management of patients in the ED with mild head trauma. Clinicians in Sweden routinely admit such patients for observation. In a recently published study conducted in that country, researchers compared outcomes in patients with mild head trauma who immediately underwent computed tomographic (CT) scanning with those who were hospitalized for observation. They hypothesized that patients with a normal CT scan and early discharge would fare just as well as those who were admitted.


Patients enrolled in the randomized, controlled study met the researchers' criteria for mild head trauma in the previous 24 hours (confirmed or suspected loss of consciousness or amnesia or both, with otherwise normal neurologic status and a Glasgow coma scale score of 15), were six years of age or older, and had no related injuries that necessitated hospitalization. In 32 months, ED physicians randomized 2,602 patients, 1,316 of whom received immediate CT scanning and 1,286 of whom were admitted for observation. The study's principal end point was an extended Glasgow coma scale score three months after the trauma by responses to a mailed, self-administered questionnaire.


Outcome data were obtained for 97% of participants. Results demonstrate that three months after injury, patients who underwent CT scanning fared as well as those admitted for observation. In the CT group, 21.4% had not recovered completely, whereas 24.2% in the observation group had not, a statistically insignificant difference. The rates of complications of injury not resulting in death were also comparable-0.3% in the CT group and 0.5% in the observation group. The three patients in the observation group who required surgical intervention care considerably delayed (by 43 to 74 days after the injury).


The investigators conclude that performing immediate CT scanning in patients with mild head trauma leads to outcomes that are similar to those seen with admission for observation, and that it may be less expensive and help to ease strains on the health care system.


af Geijerstam J-L, et al. BMJ 2006;333(7,566):465-8.