| Summary: | 碩士 === 臺北醫學大學 === 傷害防治學研究所 === 93 === We performed a retrospective study of 4271 consecutive patients with mild head injury (Glasgow Coma Scale score 13-15) who were seen during a period of 2 years. Of these, 3756 (87.9%) patients scored 15 points, 322 (7.5%) scored 14 points and 193 (4.5%) 13 points. Injuries are primarily the result of motor vehicle crashes and falls. The highest incidence of mild head injury is seen 65 years of age and older and between the ages of 15 and 24 years.
970 (22.7%) patients with acute traumatic lesions disclosed by computed tomography (CT) of the head, 334 (7.8%) required neurosurgical intervention and 237(5.5%) with unfavourable outcome (death, permanent vegetative state or severe disability).
Eight risk factors were statistically correlated with acute traumatic lesions: Gender (male), lower GCS (13-14), initial loss of consciousness, post-traumatic amnesia, seizures, focal signs, presence of skull fractures, and older age (≧65). However, this should be validated by more prospective studies.
There is a heterogeneity in pathophysiology among patients with GCS scores ranging from 13-15. Patients with GCS score 13 or 14 tended to have more serious injury. There is a statistically significant trend across GCS scores in terms of percentage of patients with positive acute radiographic findings, percentage of patients with neurosurgical interventions, and percentage of patients with poorer outcome. The current definition of mild head injury is misleading because the sequelae of the injury may not be mild. The head injury patients with GCS 13-15 should be further subdivided into "mild head injury" and "high-risk mild head injury." Mild head injury is defined as GCS 15 without any acute positive radiographic findings, whereas high-risk mild head injury is defined as GCS 13 or 14, or GCS 15 with acute positive radiographic findings. Using this more precise classification, the truly mild head injury patients can be safely discharged from the emergency department, and the high-risk mild head injury patients can either be admitted or be warned about the expected sequelae.
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