{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:37:40Z","timestamp":1788928660069,"version":"build-2803163510"},"reference-count":27,"publisher":"BMJ","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Emerg Med J"],"accepted":{"date-parts":[[2011,12,30]]},"published-print":{"date-parts":[[2012,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the frequency with which a CT head is performed in patients presenting more than 4\u2005h after minor head injury and the clinical features that predict an abnormal scan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Observational cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Emergency department (ED) of the Royal London Hospital, London, UK.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>500 patients presenting to the ED of the Royal London Hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Chart review of all patients with minor head injury presenting more than 4\u2005h from insult to the ED between December 2007 and May 2009. Inclusion criteria were: age over 16\u2005years, Glasgow coma scale (GCS) 14 or 15 on first assessment, over 4\u2005h post-injury. Exclusion criteria were: age under 16\u2005years, GCS 13 and less, injuries limited to the face with no risk of intracranial injury; presentation less than 4\u2005h after injury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Patients with minor head injury who present over 4\u2005h post-insult exhibit a similar risk of intracranial pathology to those presenting within 4\u2005h. The risk factors previously identified to predict intracranial injury are similar in this study.<\/jats:p><\/jats:sec>","DOI":"10.1136\/emermed-2011-200523","type":"journal-article","created":{"date-parts":[[2012,1,21]],"date-time":"2012-01-21T07:58:38Z","timestamp":1327132718000},"page":"983-988","source":"Crossref","is-referenced-by-count":9,"title":["Late presentations of minor head injury"],"prefix":"10.1136","volume":"29","author":[{"given":"Anna","family":"Barrow","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Ndikum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2012,1,20]]},"reference":[{"key":"2024052623412575000_29.12.983.1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2007.055723"},{"key":"2024052623412575000_29.12.983.2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01743065"},{"key":"2024052623412575000_29.12.983.3","unstructured":"NHS. National Institute for Health and Clinical Excellence. Head Injury (CG56). Triage, Assessment, Investigation and Early Management of Head Injury in Infants, Children and Adults. September 2007. http:\/\/www.nice.org.uk\/CG056 (accessed Jan 2010)."},{"key":"2024052623412575000_29.12.983.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38918.659120.4F"},{"key":"2024052623412575000_29.12.983.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200007133430204"},{"key":"2024052623412575000_29.12.983.6","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/00005373-199207000-00003","article-title":"Mild head injury: a plea for routine early CT scanning","volume":"33","author":"Stein","year":"1992","journal-title":"J Trauma"},{"key":"2024052623412575000_29.12.983.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)04561-X"},{"key":"2024052623412575000_29.12.983.8","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-200007000-00018"},{"key":"2024052623412575000_29.12.983.9","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2009.086389"},{"key":"2024052623412575000_29.12.983.10","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1136\/bmj.311.7017.1395","article-title":"Patients who re-attend after head injury: a high risk group","volume":"311","author":"Voss","year":"1995","journal-title":"BMJ"},{"key":"2024052623412575000_29.12.983.11","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000187813.79047.42"},{"key":"2024052623412575000_29.12.983.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2007.05.055"},{"key":"2024052623412575000_29.12.983.13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1227\/00006123-199301000-00002","article-title":"Clinical predictors of abnormality disclosed by computed tomography after mild head trauma","volume":"32","author":"Jeret","year":"1993","journal-title":"Neurosurgery"},{"key":"2024052623412575000_29.12.983.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-4679(97)00071-1"},{"key":"2024052623412575000_29.12.983.15","unstructured":"Scottish Intercollegiate Guidelines Network. Early Management of Patients with a Head Injury. Edinburgh: Scottish Intercollegiate Guidelines Network, 2000."},{"key":"2024052623412575000_29.12.983.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.300.6721.363"},{"key":"2024052623412575000_29.12.983.17","doi-asserted-by":"publisher","DOI":"10.1089\/089771501750357609"},{"key":"2024052623412575000_29.12.983.18","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1097\/01.TA.0000051601.60556.FC","article-title":"Time to deterioration of the elderly, anticoagulated, minor head injury patient who presents without evidence of neurological abnormality","volume":"54","author":"Reynolds","year":"2003","journal-title":"J Trauma"},{"key":"2024052623412575000_29.12.983.19","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181a7c184"},{"key":"2024052623412575000_29.12.983.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(96)70261-5"},{"key":"2024052623412575000_29.12.983.21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38918.669317.4F"},{"key":"2024052623412575000_29.12.983.22","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2005.22.1419"},{"key":"2024052623412575000_29.12.983.23","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2007.117143"},{"key":"2024052623412575000_29.12.983.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2003.10.011"},{"key":"2024052623412575000_29.12.983.25","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/j.1553-2712.1994.tb02436.x","article-title":"Identification of ethanol-intoxicated patients with minor head trauma requiring computed tomography scans","volume":"1","author":"Cook","year":"1994","journal-title":"Acad Emerg Med"},{"key":"2024052623412575000_29.12.983.26","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(95)70199-0"},{"key":"2024052623412575000_29.12.983.27","doi-asserted-by":"publisher","DOI":"10.1080\/02699050902748356"}],"container-title":["Emergency Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/emermed-2011-200523","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T06:41:35Z","timestamp":1716792095000},"score":1,"resource":{"primary":{"URL":"https:\/\/emj.bmj.com\/lookup\/doi\/10.1136\/emermed-2011-200523"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,1,20]]},"references-count":27,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2012,11,23]]},"published-print":{"date-parts":[[2012,12]]}},"alternative-id":["10.1136\/emermed-2011-200523"],"URL":"https:\/\/doi.org\/10.1136\/emermed-2011-200523","relation":{},"ISSN":["1472-0205","1472-0213"],"issn-type":[{"value":"1472-0205","type":"print"},{"value":"1472-0213","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,1,20]]}}}