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Tue Oct 2 17:29:57 BST 2007

Dear Ross,

We looked at patients who reattended with any of the
features listed on their head injury forms a few years
ago (BMJ 1995, see attached file). Fourty four of the
606 patients studied reattended with a seizure and
while 13 of these (nearly 30%) had a CT abnormality,
it was usually a contusion and seizures were not an
independent predictor of need for neurosurgery. I no
longer have the raw data so cannot tell you how many
of the 13 needed an operation, but the surgical group
was 5% overall and predicted by focal neurological
features and GCS<15.

I should say that it was a retrospective study 1988-93
and only just over half the reattenders were scanned:
we assumed that the ones who went home with analgesics
and were not seen again were OK and the study was
criticised at the time for that.  

So old data and far from definitive but on the basis
of that study, around 30% will have CT abnormality but
<5% require neurosurgery.

Miranda.
Eben Donges Hospital
Worcester
Western Cape
RSA.

Hi all,

Quick question - in patients with an isolated head
injury who do not
have other indication for CT (low GCS/worsening
LOC/focal signs) but
have a seizure, what is the incidence of
radiologically detectable
injury?  Specifically, what percentage need subsequent
neurosurgical
intervention?

Your input anticipated,
Ross.

-- 
_____________________
Ross Hofmeyr
MBChB (Stell) ATLS ACLS
wildmedic at gmail.com
ross at wildmedix.com
www.wildmedix.com

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