The role of neuroimaging in the initial management of patients with minor head injury.

STUDY

OBJECTIVE

To determine whether omitting neuroimaging in the primary assessment of patients with minor head injuries in the emergency department is safe.

DESIGN

Prospective cohort study.

SETTING

University hospital, Copenhagen County Hospital, Glostrup, Denmark.

PARTICIPANTS

The study group consisted of 2,204 patients presenting to the ED after sustaining minor head injuries. Only patients able to talk and walk were included.

MEASUREMENTS AND MAIN

RESULTS

The decision to admit was based exclusively on clinical guidelines in which the findings in the ED were of highest priority. Seven patients (0.3%) had a skull radiograph; computed tomography was not used in the primary evaluation. Four hundred thirty patients (19.5%) were admitted. After hospitalization, four patients developed intracranial complications. One required surgery, two required hyperventilation, and one was observed. Follow-up demonstrated that no patient with an intracranial complication had been missed.

CONCLUSION

We found it safe to exclude neuroimaging in the primary assessment of patients with minor head injuries in the ED, and to rely instead on clinical criteria.