Postconcussive hospital observation of alert patients in primary trauma center
Fischer, R.P.; Carlson, J.; Perry, J.F.
Journal of Trauma 21(11): 920-924
1981
ISSN/ISBN: 0022-5282 PMID: 7299860 Document Number: 176260
The medical justification for many postconcussive hospital admissions (1/4 of all trauma admissions) is unsettled, as are the potential legal consequences of nonadmission. Patients (333) with Class I level of consciousness (alert, responsive to questions and complex commands, may be disoriented and/or confused) were admitted during a 6 mo. period. Seventy-nine percent had sustained loss of consciousness. Eight-one percent were admitted solely for neurologic observation. Thirteen percent of the patients had skull fractures. Patients admitted with localized neurologic findings were most likely to have skull fractures. Thirty percent of the confirmed skull fractures occurred in patients without high yield criteria for skull roentgenograms. No deaths and no neurologic sequelae occurred among the patients without skull fractures. Among the 43 patients with skull fractures, 1 patient died of neurologic injuries, 7 patients developed major neurologic sequelae, and 8 patients required neurosurgical intervention. Only the presence of a skull fracture was of grave prognostic significance among patients with Class I level of consciousness following closed head injuries. No benefit was derived from the precautionary admission of patients with Class I level of consciousness following closed head injuries who did not sustain skull fractures.