I'd be careful about your definition of "minimal head injury" Adrian,
whatever that is! Certainly if I had an adult patient who was lethargic,
dizzy and nauseated following a head injury, they'd be in my mild to
moderate group and heading for a CT if symptoms didn't settle quickly. You can,
of course, more readily accept such symptoms for several hours in kids.
And I note James Li's definition of "traumatic syncope". Where do
people dream such terms up? The word syncope should be strictly reserved to
indicate "transitory loss of consciousness due to diminished cerebral
perfusion". Head injury, per se, does not result in syncope!
----- Original Message -----
Sent: Saturday, February 02, 2002 11:07
AM
Subject: Wafarinised head injuries
This is an interesting and difficult area. It
raises a number of issues. CT scanning should be more widely available, I'm
working in a teaching hospital which has fantastatic access to CT scanning and
it does change practice. Access in DGHs is usually controlled by an overworked
radiologist whose reluctance to come in regularly in the middle of the night
is understandable. I feel that we, as a speciality, should be able to
interpret CT scans, at least initially. The formal reporting can
be carried out the next day, as are the rest of our
radiological requests. (There are some very good books on Emergency CT
interpretation available.)
The Canadian CT head guidelines (Lancet 2001 357:
1391-96) counsel that everyone with a minor head injury and anti-coagulation
should be CT scanned. The distinction between minor head injury and minimal
head injury should be made. I suspect a lot of minimal head injuries (no loss
of consciousness, tired, light headed and nauseated ) are incorrectly
classified as minor head injuries.
Adrian
Boyle