Which type of observation for patients with high-risk mild head injury and negative computed tomography?

Abstract Objective Current guidelines suggest hospital admission followed by home monitoring for high-risk patients with mild head injury and negative computed tomography (CT). We tested early home monitoring under the care of a competent observer. Methods 1,480 patients with mild head injury and negative CT were prospectively studied. Based on clinical status and available home caretakers, patients were managed by in-hospital observation (n = 646) or early home monitoring (n = 834). Outcome measures were: a) detection of previously undiagnosed post-traumatic intracranial injury; b) neurosurgical intervention; c) unfavorable outcome (death, permanent vegetative state or severe disability). Results In the in-hospital arm, 9 cases (1.4%) developed intracranial injuries (in 3 after discharge). In the early home-monitoring arm, 6 patients (0.7%) had a previously undiagnosed lesion after readmission (P vs. in-hospital arm = 0.773). No patients with previously-undiagnosed intracranial injuries had a neurosurgical intervention. After 6 months, 5 patients had died in the home monitoring arm (0.8%) vs. 8 (1.0%) in the in-hospital arm (P= 0.785). No permanent disability or vegetative state was observed. Conclusion Early home monitoring may be safely proposed to selected “high-risk” patients, with early negative CT scan, normal clinical examination and feasible home monitoring.