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Jay - Thanks for responding.
 
Why do you adopt such a conservative stance towards minor head trauma?
 
It is my understanding that minor head trauma with minimal LOC/amnesia + GCS
of 15 has a very low incidence of neurosurgical pathology - less than
1:1,000. What is the importance of detecting benign intracranial pathology
(very small cerebral contusions, minute intraparenchymal bleeds, very small
subdurals) if the patients do not require any specific therapy? It is my
understanding that a large number of studies have revealed that these minor
traumatic lesions do not evolve over time and do not require any surgical or
medical therapy.
 
You mention that you would do a CT scan if the minor head injury patient has
any symptoms at 3-4 hours. Again, it is my understanding that a number of
studies suggest that there may no correlation, or even a reverse
correlation, between minor post-concussion symptoms and the risk of
intracranial pathology.  Sevadei even suggested that the risk of
intracranial pathology was twice as high in children who did not vomit
compared to children, who did vomit after head trauma.
 
Jeff.
 
"Jay D. Fisher" wrote:
 
> Thanks Jeff!
>
> 1) I am referring to the diagnosis of intracranial hemorrhage or
> cerebral injury of any kind in all my 'diagnositic accuracy'
> assessments. I am not distinguishing between operable or 'benign'
> lesions.
>
> 2) Once again, I am not making a distinction here. I should state,
> however, that I have been involved with more than one patient having an
> epidural hemorrhage that required surgery with a 'nearly normal' exam
> (GCS = 15, no lateralizing signs).
>
> 3) I CT kids who are symptomatic at 3 - 4 hours, regardless of their
> physical exam. 'Symptomatic' would include vomiting, 'real' headache, or
> 'Gee doctor I really don't feel right'.
>
> Thanks again.
>
> Jay Fisher
 
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