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Head Injury (cont.)


How Is a Head Injury Diagnosed?

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

What Are Home Remedies to Treat a Head Injury?

Many people who hit their heads do not need to seek medical attention. People often hit their heads on a cupboard or trip and fall on a soft surface, get up and dust themselves off and are otherwise well.

Occasionally, a bump can occur underneath the skin of the scalp or forehead. This 'goose egg' is a hematoma on the outside of the skull and is not necessarily related to any potential bleeding that can affect the brain. Treatment is the same as any other bruise or contusion and includes ice, and over-the-counter pain medication.

What Is the Medical Treatment for a Head Injury?

Treatment for head injury will be individualized for each patient depending upon the underlying injury and the patient's situation.

As with any other injury, the ABCs of resuscitation take priority to restore or support breathing and circulation in the body. Care for the head injury often occurs at the same time other injuries are attended to in the multiply traumatized patient.

How Do I Prevent a Head Injury?

  • Falls are the number one cause of head injuries. Some, like toddlers falling when learning to walk, are unavoidable. Others may be preventable, especially in the elderly. Opportunities exist to minimize the risk of falling at home with the use of proper floor coverings, the use of assist devices such as canes and walkers, and by evaluating homes for high risk areas like bathrooms and stairs. A primary care health care practitioner or a county health nurse may be able to help with home assessment.
  • Routine use of helmets may decrease head injury while riding a bicycle or motorcycle. Their use is also encouraged for sporting activities like skateboarding, skiing, and snowboarding.
  • Head injuries are a major consequence of motor vehicle crashes. Lives can be saved by wearing seatbelts, driving cars with air bags, and by avoiding risky driving behavior (drinking and driving, texting while driving).

What Is the Prognosis for a Head Injury?

The recovery from head injury depends upon the amount of damage inflicted upon the brain. Not surprisingly, the brain cannot recover from severe injury, but the goal of treatment is to return as much function as possible.

Of note is that concussion, once thought to be relatively minor, may have more long-term effects than initially appreciated and should not be ignored.

Medically reviewed by Joseph Carcione, DO; American board of Psychiatry and Neurology


American Academy of Pediatrics.

Centers for Disease Control and Prevention. Injury Prevention & Control: Traumatic Brain Injury.

Stiel IG, et al. The Canadian CT Head Rule for Patients with Minor Head Injury. Lancet 2001;357:1391-96.

S.A. Schutzman, MD, P. Barnes MD, A. Duhaime, MD, D. Greenes, MD, C. Homer, MD, D. Jaffe, MD, R. J. Lewis, MD, PHD, T. G. Luerssen, MD, J. Schunk, MD; "Evaluation and Management of Children Younger Than Two Years Old With Apparently Minor Head Trauma: Proposed Guidelines." Journal of the American Academy of Pediatrics, Vol. 107 No. 5

Wolfson AB. Harwood-Nuss' Clinical Practice of Emergency Medicine. Lippincott Williams and Wilkins 2009.

Medically Reviewed by a Doctor on 11/21/2017

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