Minor head injuries and outcomes in the emergency department

Though outcomes of the minor head injuries (MHI) were considered to be insignificant in the past, recently it has been reported that it is associated with persistent symptoms up to 15% rates and, patients who have not been diagnosed are at the risk of complicated recovery. The primary objective of this study was to evaluate the Postconcussional Syndrome (PCS)-related complaints through patient perception, to provide data on the frequency and severity of PCS, to reveal the need for information and guidance to increase the quality of patient care, and to raise physician awareness. Obtaining data on the management of MHI and the use of CT (computed tomography) in our clinic was determined as a secondary objective. 454 patients with MHI were included in the study. All patients scored 15 on the Glasgow Coma Scale(GCS) and had no history of head injury in the last week. In patients with MHI, cranial pathology in head CT was found 2.4%, posttraumatic amnesia (PTA) in 3.5%, and loss of consciousness was found 11.7%. The presence of PCS symptoms was questioned by telephone interviews on the 3rd and 6th months after the discharge. The presence of at least 3 symptoms lasting more than 3 months was defined as PCS. No patients had developed PCS neither at 3rd or 6th months. The ratio of patients who did not meet the NEXUS II, New Orleans, and Canada head CT criteria but received CT imaging was 12% and, the negative predictive value of 99%, 100%, and 98.5%, the positive predictive value of 4.85%, 2.96%, and 3.18% was calculated for all 3 criteria respectively. Discharge information about the head injury was not given to 13.2% of the patients discharged from the emergency department and 32.2% of the patients admitted to the hospital. In conclusion, in this study, it was found that patients with a GCS of 15 and no history of recurrent head trauma in the last week could be discharged safely in terms of the risk of PCS development. However, our study does not include data on complicated injuries with high levels of traumatic lesions in head CT and PTA or loss of consciousness. Further research is needed in this respect. Additionally, considering the cost, resource use, and harmful effects of iv radiation, the use of CT in patients with low-risk MHI should be reduced and physician awareness should be increased in our clinic.