Reassurance, Not Routine Follow-Up, Indicated After Most Head Injury
October 1, 1997
Reassurance, Not Routine Follow-Up, Indicated After Most Head Injury
Source: Wade DT, et al. Does routine follow up after head injury help? A randomized controlled trial. J Neurol Neurosurg Psychiatry 1997;62:478-484.
Most head injuries require no hospitalization, outnumbering admissions by a ratio of 5:1 (Klonoff H, et al. Can Med Assoc J 1969;100:235-241). How many require even a routine follow-up visit? Wade et al studied 226 control" (standard care) and 252 "trial" (standard care plus early follow-up) head injury patients aged 16-65 years. Half were given early follow-up at 7-10 days after injury and offered further support, if needed. Nevertheless, no significant differences regarding post-concussion symptoms were seen at six months overall in the mild head injury subgroup (post-traumatic amnesia < 1 hour). Among those with greater than one hour post-traumatic amnesia or admitted to hospital, however, early intervention resulted in significantly fewer difficulties, as identified by the Rivermead head injury follow up questionnaire (P = 0.03). Clearly, patients with mild head injury (no retrograde amnesia lasting more than an hour) merit immediate reassurance rather than a return visit. More severe injuries, however, respond more favorably when given attention at 7-10 days post trauma rather than waiting a full six months. mr
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