‘Minor’ head injury

Wednesday, March 18, 2009

“What if” is a hard game to play, especially if you don’t have all the facts and the speculation that can run rampant doesn’t help understand the situation.

Natasha Richardson, the acclaimed actress was taking a ski lesson yesterday outside of Montreal, when she seemingly had a relatively minor fall and hit her head. Over the next couple of hours, she complained of increasing headache, was taken to a local headache and by all reports is now critically ill in coma in a New York hospital. The type of brain injury she sustained has not been revealed. A variety of news outlets are trying to guess what happened. We won’t play what if, but it is fair to talk about minor head trauma and the potential that it turns into major head trauma

Minor head injuries are defined as those where trauma causes a transient loss of mental function, however, there is still a potential risk that something bad might happen. In fact, there are numerous guidelines to help physicians decide who might need a CT scan to look for brain bleeding or injury. The February 2009 edition of the Annals of Emergency Medicine contained an article that compared six different sets of guidelines. The conclusion was that each worked equally well in predicting who may or may not have bleeding in the brain. If the symptoms were not present, then it was safe to reassure the patient and family and let them go home. If symptoms were there, a CT scan was needed to look for damage.

Often, the injury that causes brain damage may not be dramatic or very traumatic and the person may not initially lose consciousness. But for those few, where the head is hit in just the right place with just the right amount of force, the potential for swelling in the brain is a real potential. The fear of every emergency doctor is that the normal patient they see with a head injury and is sent home, returns in a few hours in coma.

The New Orleans Criteria found 7 symptoms that would suggest getting a CT scan. These same 7 symptoms are reasonable as a guide to seek medical attention after a head injury:
• Headache
• Vomiting
• Short term memory loss
• Alcohol intoxication
• Seizure
• Physical evidence of trauma to the head or neck
• Age over 60

Other guidelines would add dangerous mechanism of injury like being hit by a car or falling down steps and being on a blood thinner like coumadin or Plavix.

Head injuries are all too common, with almost 250,000 admissions to hospitals in the US each year and an estimated 50,000 deaths. Car wrecks and sports injuries account for up to 90% of these injuries. Kids aren’t immune with over 2,500 deaths each year in children under the age of 14.

No matter the brain injury that caused Ms. Richardson’s coma, it seems that the trauma relatively minor and she was supremely unlucky. The ski patrol who evaluated her and the ski instructor who stayed by her side, seemed to follow the guidelines by getting her to the hospital when Richardson’s headache began. How sad that even when things are done right, the outcome can be so sad.

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