Medical outcome after immediate computed tomography or admission for observation in patients with mild head injury: randomised controlled trial
- PMID: 16895944
- PMCID: PMC1557917
- DOI: 10.1136/bmj.38918.669317.4F
Medical outcome after immediate computed tomography or admission for observation in patients with mild head injury: randomised controlled trial
Abstract
Objective: To compare immediate computed tomography during triage for admission with observation in hospital in patients with mild head injury.
Design: Multicentre, pragmatic, non-inferiority randomised trial.
Setting: 39 acute hospitals in Sweden.
Participants: 2602 patients (aged > or = 6) with mild head injury.
Interventions: Immediate computed tomography or admission for observation.
Main outcome measure: Dichotomised extended Glasgow outcome scale (1-7 v 8). The non-inferiority margin was 5 percentage points.
Results: At three months, 275 patients (21.4%) in the computed tomography group had not recovered completely compared with 300 (24.2%) admitted for observation. The difference was - 2.8 percentage points, non-significantly in favour of computed tomography (95% confidence interval - 6.1% to 0.6%). The worst outcomes (mortality and more severe loss of function) were similar between the groups. In the patients admitted for observation, there was a considerable delay in time to treatment in those who required surgery. None of the patients with normal findings on immediate computed tomography had complications later. Patients' satisfaction with the two strategies was similar.
Conclusions: The use of computed tomography in the management of patients with mild head injury is feasible and leads to similar clinical outcomes compared with observation in hospital.
Trial registration: ISRCTN81464462.
Figures
Comment in
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Managing minor head injury in children.BMJ. 2006 Sep 2;333(7566):455-6. doi: 10.1136/bmj.38954.516933.DE. BMJ. 2006. PMID: 16946318 Free PMC article. No abstract available.
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Immediate CT scan followed by early discharge may be appropriate management for selected patients with mild head injury.J Pediatr. 2007 Mar;150(3):321. doi: 10.1016/j.jpeds.2006.12.030. J Pediatr. 2007. PMID: 17307560 No abstract available.
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Strategies for management of acute mild head injury.Clin J Sport Med. 2007 Jul;17(4):332-3. doi: 10.1097/JSM.0b013e31812568f8. Clin J Sport Med. 2007. PMID: 17620798 No abstract available.
References
-
- Peloso PM, Carroll LJ, Cassidy JD, Borg J, von Holst H, Holm L, et al. Critical evaluation of the existing guidelines on mild traumatic brain injury. J Rehabil Med 2004;43 suppl: 106-12. - PubMed
-
- De Kruijk JR, Twijnstra A, Meerhoff S, Leffers P. Management of mild traumatic brain injury: lack of consensus in Europe. Brain Inj 2001;15: 117-23. - PubMed
-
- Blostein P, Jones SJ. Identification and evaluation of patients with mild traumatic brain injury: results of a national survey of level I trauma centers. J Trauma 2003;55: 450-3. - PubMed
