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Impact of early intervention on outcome following mild head injury in adults
  1. A M Salazar
  1. 3203 Cleveland Avenue NW, Washington DC 20008, USA
  1. Correspondence to:
 Professor A M Salazar;
 asalazar{at}starpower.net

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Written information is valuable to injured patients

In this issue, the paper “Impact of early intervention upon outcome following mild head injury in adults” by Ponsford and colleagues (pp 330–2)1 describes a valuable study addressing an important current issue in public health. The authors have made a strong case for the early use of a relatively inexpensive written information booklet in the management of patients with mild head injury. These findings thus reinforce the notion that many elements of emergency room counselling, albeit important, are likely to be forgotten by a patient under stress and particularly in the context of a recent concussion. Clinicians too often underappreciate the therapeutic value of information to an otherwise intelligent patient in such circumstances.

As expected from prior studies, the purely cognitive and neurological signs and symptoms related to mild head injury are largely recovering by three months after the injury, although stress related symptoms often persist in a subset of patients.2 The differential recovery in stress related symptoms between treatment groups in this study is further testimony to the importance of these symptoms to quality of life, as well as to their amenability to proper early management.

Although the study was not strictly randomised, patients were alternately assigned to the two treatment groups from consecutive emergency room admissions, and the authors have otherwise shown comparability of the two groups. The differential dropout between treatment groups is unfortunate but not unexpected. Otherwise recovering patients might have been expected to be reluctant to subject themselves to repeated neuropsychological testing. A simple telephonic follow up might have provided critical information on stress symptoms for such patients and should be included in any future confirmatory studies.

Future studies should also examine the essential elements of written materials given to patients. How much detail is enough? How much detail is excessive? Separately, how much of a role, if any, does early (and relatively expensive) neuropsychological evaluation have in treatment? The authors acknowledge the impracticality of such testing on a routine basis, but can a simpler (perhaps computerised) battery targeted at mild head injury provide the same benefit and identify patients requiring more attention? Finally, if we acknowledge that pathological brain abnormalities related to the trauma are the basis of the morbidity associated with mild traumatic brain injury, is there also a role for the use of simple, non-toxic neuroprotective agents in such patients? In any case, based on the current findings, written information booklets in one form or other should become part of standard treatment for any such future studies of mild traumatic brain injury.

Written information is valuable to injured patients

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