Emerg Med J 29:983-988 doi:10.1136/emermed-2011-200523
  • Original articles

Late presentations of minor head injury

  1. Tim Harris1,2
  1. 1Emergency Department, The Royal London Hospital, London, UK
  2. 2Pre-Hospital Care, London HEMS, London, UK
  1. Correspondence to Dr Anna Barrow, ST3 Anaesthesia, Department of Anaesthesia, The Royal London Hospital, Whitechapel, London E1 1BB, UK; annarachelbarrow{at}
  1. Contributors AB and JN were responsible for data collection. All three authors contributed to the literature review, analysis and final write-up.

  • Accepted 30 December 2011
  • Published Online First 20 January 2012


Objective To determine the frequency with which a CT head is performed in patients presenting more than 4 h after minor head injury and the clinical features that predict an abnormal scan.

Design Observational cohort study.

Setting Emergency department (ED) of the Royal London Hospital, London, UK.

Participants 500 patients presenting to the ED of the Royal London Hospital.

Methods Chart review of all patients with minor head injury presenting more than 4 h from insult to the ED between December 2007 and May 2009. Inclusion criteria were: age over 16 years, Glasgow coma scale (GCS) 14 or 15 on first assessment, over 4 h post-injury. Exclusion criteria were: age under 16 years, GCS 13 and less, injuries limited to the face with no risk of intracranial injury; presentation less than 4 h after injury.

Results 497 patients were identified: 147 patients had CT head; 11 had intracranial injuries on CT. Loss of consciousness (p=0.0005), potential coagulopathy (p=0.0015), injuries above the clavicles (p=0.0150), open/depressed skull fracture (p=0.0221), alcohol/drug intoxication (p=0.0406) and focal neurology (p=0.0562) were predictors of positive CT scan. Five patients (1% of sample, 45% of patients with abnormal CT) required a neurosurgical procedure. Two (18.2%) self-discharged and four (36.4%) were followed up as outpatients. One patient (0.09%) died as a result of intracranial injury.

Discussion Patients with minor head injury who present over 4 h post-insult exhibit a similar risk of intracranial pathology to those presenting within 4 h. The risk factors previously identified to predict intracranial injury are similar in this study.


  • Competing interests None.

  • Ethics approval The study was registered as an audit of current practice with the Department of Clinical Governance in the authors' trust. A written application to the local ethics committee was made. However, as the work involved no deviation from normal practice, no change to department guidelines, no interventions and all data were retrospective and anonymised, the authors were advised that formal IRAS application and written consent were not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of EMJ.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.


Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

Navigate This Article