Head Injury Epidemiology Aetiology Assessment Prehospital management Admission Patients not requiring admission Investigations Investigations for the cervical spine Indications for neurosurgical opinion Management Complications Prognosis Prevention * This article particularly refers to the National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) clinical guidelines for head injury. * Head injury can arise from blunt or penetrating trauma and result in direct injury at the impact site. Indirect injury may also be caused by movement of the brain within the skull, leading to contusions on the opposite side of the head from the impact, or disruptive injuries to axons and blood vessels from shearing or rotational forces as the head is accelerated and decelerated after the impact. * Traumatic brain injury may be categorised as primary (damage occurring at the time of impact) or secondary (injury as a result of neurophysiological and anatomical changes minutes to days following primary insult - eg, from cerebral oedema, haematoma or increased intracranial pressure). 1. Epidemiology Hospital Episode Statistics data for the 2012-2013 annual dataset indicate that there were 171,600 admissions to hospitals in England with a primary diagnosis of head injury. 70% are males. 33-50% are children under 15 years of age. There is an increasing number of patients admitted with head injuries aged ≥75 years (approaching 40%). Severe traumatic brain injury defined as Glasgow Coma Score (GCS) 90 mm Hg ensuring an adequate cerebral perfusion pressure - eg, boluses of 0.9% normal saline c). Full cervical spine immobilisation Attempted (unless other factors prevent this) if: * GCS is
Posted on: Thu, 20 Nov 2014 09:52:00 +0000
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