Mild Head Injury – In hospital Observation or Computed Tomography?

Revision of SBU report no 153

SBU:s Conclusions

Head injury that causes short-term unconsciousness and/or memory loss is referred to as mild head injury (concussion). This report reviews the scientific evidence for two acute management strategies for mild head injury – in-hospital observation or computed tomography (CT scanning) and discharge. The report reviews the benefits and risks for patients, as well as the costs to healthcare and society.

• CT scanning and discharge are clinically equivalent to hospital observation for patients aged 6 or older with mild head injury (Evidence Grade 2). No studies have directly compared hospital observation with CT scanning and discharge in children under 6 years of age.
• A patient with mild head injury and normal CT findings faces only a small risk of developing a serious complication within a few days (Evidence Grade 1).
• The costs of acute management for patients with mild head injury are approximately 30% lower with the CT strategy than hospital observation (Evidence Grade 1).
• Patient satisfaction is similar and very high with both strategies (Evidence Grade 1).
• In-hospital observation is currently the predominant management strategy for Swedish patients with mild head injury.
• A head CT scan averages a radiation dose of 15–30 mGy in children under 2 years of age, 30–60 mGy in children aged 2–15 and 50–70 mGy in adults. Optimizing equipment and implementation can reduce doses even more at many hospitals. No radiation dose recommendations have been issued for head CT scans in children.
• Although no studies have directly explored the risks of CT scans in patients with mild head injury, correct indications and optimized radiation doses can ensure that the risks for children over 18 months of age and adults are very small. For a child under 18 months, the small risk of future injury must be carefully weighed on an individual basis against the benefits of a CT scan at the acute stage.
• A search of the Swedish National Board of Health and Welfares risk database and Patient Insurances injury database for 1997–2005 identified 32 cases associated with initial management of patients with mild head injury. None of the patients had undergone early CT scans.