Management of Head Injury

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Abstract
Drs. White and Likavec have provided a useful review of the management of head injury (Nov. 19 issue),1 but I was startled to read their advice that “aside from truly asymptomatic patients in the low-risk group, all should undergo CT [computed tomographic] scanning.” This strikes me as the kind of advice issued by specialists who deal with a selected subgroup of patients with head injuries. As a specialist in emergency medicine, I see a daily procession of patients with head injuries, very few of whom are completely asymptomatic. Careful history-taking often yields unclear information, which makes it difficult to categorize patients into the various risk groups. Alcohol-intoxicated patients are numerous and often present repeatedly to the same emergency department with minor head wounds. Should such patients have a CT scan on each visit? Other problems abound. Many hospitals do not have in-house, 24-hour-a-day CT coverage. The escalating use of CT in emergency medicine may strain an institution's resources, with a certificate of need necessary to acquire a second scanner. The cost-benefit ratio is not clear; what yield is expected from scanning the many low-risk patients who have some symptoms?