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Head Injury (cont.)

Head Injury Diagnosis

The physical examination and the history of the exact details of the injury are the first steps in caring for a patient with head injury. The patient's past medical history and medication usage will also be important factors in deciding the next steps. Plain skull X-rays are rarely done for the evaluation of head injury. It is more important to assess brain function than to look at the bones that surround the brain. Plain X-ray films may be considered in infants to look for a fracture, depending upon the clinical situation.

Computerized tomography (CT) scan of the head allows the brain to be imaged and examined for bleeding and swelling in the brain. It can also evaluate bony injuries to the skull and look for bleeding in the sinuses of the face associated with basilar skull fractures. CT does not assess brain function, and patients suffering axonal shear injury may be comatose with a normal CT scan of the head.

Numerous guidelines exist to give direction as to when a CT should be completed in patients who present awake after sustaining a minor head injury.

The Ottawa CT head rules apply to patients age 2 to 65.

High Risk

  • Glasgow Coma Scale less than 15, two hours after injury
  • Suspect open or depressed skull fracture
  • Sign of basilar skull fracture
  • Vomiting more than once
  • Older than 65 years of age

Medium Risk

  • Amnesia before impact greater than 30 minutes
  • Dangerous mechanism of injury
Medically Reviewed by a Doctor on 6/4/2014

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Read What Your Physician is Reading on Medscape

Head Injury »

Head injury can be defined as any alteration in mental or physical functioning related to a blow to the head.

Read More on Medscape Reference »


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