Article Text

other Versions

PDF
A history of loss of consciousness or post-traumatic amnesia in minor head injury: “conditio sine qua non” or one of the risk factors?
  1. Marion Smits (marion.smits{at}erasmusmc.nl)
  1. Erasmus MC - University Medical Center Rotterdam, Netherlands
    1. M.G. Myriam Hunink (m.hunink{at}erasmusmc.nl)
    1. Erasmus MC – University Medical Center, Rotterdam, Netherlands
      1. Paul J. Nederkoorn (p.j.nederkoorn{at}amc.uva.nl)
      1. Academic Medical Center, Netherlands
        1. Helena M. Dekker (h.dekker{at}rad.umcn.nl)
        1. University Medical Center Nijmegen St. Radboud, Netherlands
          1. Pieter E. Vos (p.vos{at}neuro.umcn.nl)
          1. University Medical Center Nijmegen St. Radboud, Netherlands
            1. Digna R. Kool (d.kool{at}rad.umcn.nl)
            1. Academic Medical Center, Amsterdam, Netherlands
              1. Paul A.M. Hofman (p.hofman{at}rad.unimaas.nl)
              1. University Hospital Maastricht, Netherlands
                1. Albert Twijnstra (atw{at}sneu.azm.nl)
                1. University Hospital Maastricht, Netherlands
                  1. Gijs G. de Haan (gijsdehaan{at}netscape.net)
                  1. Erasmus MC – University Medical Center, Rotterdam, Netherlands
                    1. Herve L.J. Tanghe (h.l.j.tanghe{at}erasmusmc.nl)
                    1. Erasmus MC – University Medical Center, Rotterdam, Netherlands
                      1. Diederik W.J. Dippel (d.dippel{at}erasmusmc.nl)
                      1. Erasmus MC – University Medical Center, Rotterdam, Netherlands

                        Abstract

                        Objective: A history of loss of consciousness (LOC) or post-traumatic amnesia (PTA) is commonly considered a prerequisite for minor head injury (MHI), although neurocranial complications also occur when LOC/PTA are absent, particularly in the presence of other risk factors. Purpose of this study was to evaluate whether known risk factors for complications after MHI in the absence of LOC/PTA have the same predictive value as when LOC/PTA are present.

                        Methods: A prospective multicenter study was performed in 4 university hospitals between February 2002 and August 2004 of consecutive blunt head injury patients (≥ 16 years) presenting with a normal level of consciousness and a risk factor. Outcome measures were any neurocranial traumatic CT finding and neurosurgical intervention. Common odds ratios (OR) were estimated for each of the risk factors and tested for homogeneity.

                        Results: 2,462 patients were included: 1,708 with and 754 without LOC/PTA. Neurocranial traumatic findings on CT were present in 7.5% and were more common when LOC/PTA was present (8.7%). Neurosurgical intervention was required in 0.4%, irrespective of the presence of LOC/PTA. ORs were comparable across the two subgroups (p>0.05), except for clinical evidence of a skull fracture, with high ORs both when LOC/PTA was present (OR=37, 95%CI=17-80) or absent (OR=6.9, 95%CI=1.8-27). LOC and PTA had significant ORs of 1.9 (95%CI=1.0-2.7) and 1.7 (95% CI=1.3-2.3) respectively.

                        Conclusion: Known risk factors have comparable ORs in MHI patients with or without LOC or PTA. MHI patients without LOC or PTA need to be explicitly considered in clinical guidelines.

                        • Amnesia, retrograde
                        • Brain Concussion
                        • Craniocerebral trauma
                        • Tomography, X-ray Computed
                        • Unconsciousness

                        Statistics from Altmetric.com

                        Request permissions

                        If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.