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

Abstract

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.