© 2004 BMJ Publishing Group & Royal College of Paediatrics and Child Health
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Following minor head trauma, we ask ourselves two important questions—who should be imaged and who should be admitted? Unfortunately, despite two decades of research, the answers to these questions remain elusive. In anticipation of a number of reports from various cooperative studies being conducted in the UK, Canada, and various other countries, Dunning and colleagues from the Manchester Royal Infirmary, report the results of a meta-analysis that examined variables that predict significant intracranial injury following minor head trauma. Not surprisingly, there were a large number of reports to analyse—16, involving 22 420 patients. Unfortunately, the results are consistent with conventional wisdom; skull fracture, focal neurological exam, and a Glasgow Coma Scale below 15 have the greatest relative risk for intracranial haemorrhage. Headache and vomiting are not particularly useful, and seizures and level of consciousness are of intermediate importance. Where does this study leave us? First, it points out the limitations
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