Head trauma.

Abstract

Head injury is a common occurrence in the multiply injured patient. Because it is so common, physicians in busy emergency rooms should be well versed in its evaluation and treatment. A guide to appropriate evaluation and treatment has been established by Becker et al. Patients can be divided into four categories, depending on degree of neurologic injury. Group I patients suffer transient loss of consciousness only and then return to normal; they require observation only. Group II patients suffer loss of consciousness and continue to have impaired cognitive functions; they require observation and a CT scan. Group III patients suffer loss of consciousness, continue to have disordered cognitive functions, and have significant motor deficits. This group can be subdivided into patients with and without focal neurologic deficits. Both of these will require aggressive therapy to control intracranial hypertension, CT scanning, and possibly surgery. The last category, group IV, includes patients who meet the requirements of brain death. No further work-up or therapy is needed for this group. Patients who suffer head injury are at risk for many complications, but two that are emphasized are postconcussion seizures and the postconcussion syndrome. Identifying factors that predispose the patient to these complications can help to minimize their occurrence.