Management of mild head injuries in the emergency department of a tertiary hospital. Neurosurgical perspectives

OBJECTIVE To study the management of patients with mild traumatic brain injury in the emergency department of a tertiary hospital with reference to the need for neurosurgical assessment, according to international guidelines. METHOD A retrospective study was conducted at the Thessaloniki General Hospital "Ippokratio" over a 13-month period. The records of all patients with traumatic brain injury recorded in the registry of the general surgery emergency department who had been evaluated by a neurosurgeon were included and the need for neurosurgical assessment was evaluated. RESULTS Of the studied patients, 76% were examined by a neurosurgeon without having previously undergone brain computed tomography (CT) scan. The vast majority of them (89.8%) had no clinical signs of moderate or severe brain injury, but according to international guidelines the remaining 10.2% should have undergone brain CT scan after initial assessment and resuscitation and before neurosurgical evaluation. CONCLUSIONS Head trauma is a common reason for seeking medical attention in the emergency department of tertiary hospitals in Greece, mainly because of the shortage of a well-organized primary health care system. Proper assessment and treatment of these patients is of vital importance, from both the medical and financial perspective. The lack of formal traumatic brain injury guidelines puts an unnecessary burden on the emergency department personnel, increasing the workload and the cost to the health care system. The implementation of relevant guidelines on the management of traumatic head injury, equivalent to those applied internationally, along with specialized training of the emergency personnel, is expected to improve the quality of emergency health care services in Greece.