{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:45:14Z","timestamp":1790232314888,"version":"4.1.0"},"reference-count":31,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1986,8]]},"abstract":"<jats:p content-type=\"fine-print\">\u2713 A small number of patients with an apparently minor head injury will develop a life-threatening intracranial hematoma that must be rapidly detected and removed. To assess the risk of a significant intracranial neurosurgical complication after apparently minor head injury, the authors collected data prospectively on 610 patients who had sustained a transient posttraumatic loss of consciousness or other neurological function and who had a Glasgow Coma Scale (GCS) score of 13, 14, or 15 in the emergency room. Skull x-ray films were obtained in 583 patients, 66 of whom (10.8% of the study population) had cranial fractures. Eighteen of the 610 patients (3.0%) required a neurosurgical procedure. Three acute subdural hematomas, one epidural hematoma, and one traumatic intracerebral hematoma required craniotomy. Of the 66 patients who had skull fracture, 7.6% required a craniotomy for intracranial hematoma. Thirteen (19.7%) of the 66 patients with skull fracture required an operative procedure as compared to five (1.0%) of the 517 patients without skull fracture. Two patients with a normal GCS score of 15 and normal skull x-ray films subsequently underwent operative treatment.<\/jats:p>\n<jats:p content-type=\"fine-print\">The cost of three alternative management schemes for these patients was estimated. A 50% reduction in cost of management could be effected by the use of computerized tomography (CT) scans (or possibly skull x-ray films) in determining which of the patients who are alert at the time of presentation should be admitted for observation. Several other conclusions can be drawn from this study. First, an initial GCS score between 13 and 15 does not necessarily indicate that a patient has sustained a trivial head injury, since 3% of such patients will require an operative procedure despite an initially normal level of alertness. Second, an abnormal skull x-ray film increases by a factor of 20 the probability that a patient will need neurosurgical treatment. Third, it is very unusual for patients who have a GCS score of 15 and a normal skull x-ray film to have a significant neurosurgical complication. Fourth, the alternative management schemes that depend on selective use of skull films and CT scans may significantly reduce the cost of caring for patients with minor head injury.<\/jats:p>","DOI":"10.3171\/jns.1986.65.2.0203","type":"journal-article","created":{"date-parts":[[2009,5,8]],"date-time":"2009-05-08T16:22:26Z","timestamp":1241799746000},"page":"203-210","source":"Crossref","is-referenced-by-count":194,"title":["Neurosurgical complications after apparently minor head injury"],"prefix":"10.3171","volume":"65","author":[{"given":"Ralph G.","family":"Dacey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne M.","family":"Alves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca W.","family":"Rimel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. Richard","family":"Winn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Jane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"491","DOI":"10.3171\/jns.1977.47.4.0491","article-title":"The outcome from severe head injury with early diagnosis and intensive management.","volume":"47","author":"Becker","year":"1977"},{"key":"b2","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1056\/NEJM197102042840504","article-title":"The utility and futility of radiographic skull examination for trauma.","volume":"284","author":"Bell","year":"1971"},{"key":"b3","series-title":"Br Med J","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1136\/bmj.288.6422.983","article-title":"Guidelines for initial management after head injury in adults. Suggestions from a group of neurosurgeons.","volume":"288","author":"Briggs","year":"1984"},{"key":"b4","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1227\/00006123-198308000-00005","article-title":"Role of emergency skull x-ray films in the evaluation of the head-injured patient: a retrospective study.","volume":"13","author":"Cooper","year":"1983"},{"key":"b5","series-title":"Clin Radiol","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/S0009-9260(80)80194-2","article-title":"Mild head injuries: a source of excessive radiography? (Analysis of a series and review of the literature.)","volume":"31","author":"de Lacey","year":"1980"},{"key":"b6","series-title":"AJR","doi-asserted-by":"publisher","first-page":"95","DOI":"10.2214\/ajr.132.1.95","article-title":"A second look at the utility of radiographic skull examination for trauma.","volume":"132","author":"DeSmet","year":"1979"},{"key":"b7","series-title":"Lancet","first-page":"85","article-title":"Post-traumatic skull radiographs. Time for a reappraisal.","volume":"2","author":"Eyes","year":"1978"},{"key":"b8","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1097\/00005373-198111000-00002","article-title":"Postconcussive hospital observation of alert patients in a primary trauma center.","volume":"21","author":"Fischer","year":"1981"},{"key":"b9","series-title":"Br Med J","doi-asserted-by":"publisher","first-page":"1438","DOI":"10.1136\/bmj.1.6023.1438","article-title":"Misdiagnosis and delayed diagnosis in traumatic intracranial haematoma.","volume":"1","author":"Galbraith","year":"1976"},{"key":"b10","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1097\/00005373-198401000-00006","article-title":"Epidemiologic features of head injury in a predominantly rural population.","volume":"24","author":"Jagger","year":"1984"},{"key":"b11","series-title":"Practitioner","first-page":"77","article-title":"The problem of mild head injury.","volume":"221","author":"Jennett","year":"1978"},{"key":"b12","series-title":"Clin Radiol","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1016\/S0009-9260(80)80195-4","article-title":"Skull x-rays after recent head injury.","volume":"31","author":"Jennett","year":"1980"},{"key":"b13","series-title":"Lancet","first-page":"850","article-title":"Relative risk of alternative admission policies for patients with head injuries.","volume":"2","author":"Jones","year":"1981"},{"key":"b14","series-title":"J Neurosurg","first-page":"S19","article-title":"The National Head and Spinal Cord Injury Survey: major findings.","volume":"53","author":"Kalsbeek","year":"1980"},{"key":"b15","series-title":"J Neurosurg","first-page":"S3","article-title":"Injury to the head and spinal cord. The epidemiological relevance of the medical literature published from 1960 to 1978.","volume":"53","author":"Kraus","year":"1980"},{"key":"b16","series-title":"Neurochirurgia (Stuttg)","first-page":"62","article-title":"Computer-tomographische und neurologische Verlaufsbeobachtungen in der Akutphase gedeckter Sch\u00e4delhirnverletzungen.","volume":"27","author":"Liesegang","year":"1984"},{"key":"b17","series-title":"AJR","doi-asserted-by":"publisher","first-page":"539","DOI":"10.2214\/ajr.135.3.539","article-title":"Evaluation of head trauma: efficacy of skull films.","volume":"135","author":"Masters","year":"1980"},{"key":"b18","series-title":"Br Med J","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1136\/bmj.285.6354.1530","article-title":"Admission after mild head injury: benefits and costs.","volume":"285","author":"Mendelow","year":"1982"},{"key":"b19","series-title":"Br Med J","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1136\/bmj.287.6400.1173","article-title":"Risks of intracranial haematoma in head injured adults.","volume":"287","author":"Mendelow","year":"1983"},{"key":"b20","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"503","DOI":"10.3171\/jns.1977.47.4.0503","article-title":"Significance of intracranial hypertension in severe head injury.","volume":"47","author":"Miller","year":"1977"},{"key":"b21","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"289","DOI":"10.3171\/jns.1981.54.3.0289","article-title":"Further experience in the management of severe head injury.","volume":"54","author":"Miller","year":"1981"},{"key":"b22","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"650","DOI":"10.3171\/jns.1982.56.5.0650","article-title":"Intracranial pressure: to monitor or not to monitor? A review of our experience with severe head injury.","volume":"56","author":"Narayan","year":"1982"},{"key":"b23","series-title":"Lancet","first-page":"791","article-title":"Costs and benefits of skull radiography for head injury.","volume":"2","author":"A National Study by the Royal College of Radiologists","year":"1981"},{"key":"b24","series-title":"Lancet","first-page":"115","article-title":"Patient selection for skull radiography in uncomplicated head injury.","volume":"1","author":"A National Study by the Royal College of Radiologists","year":"1983"},{"key":"b25","series-title":"JACEP","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/S0361-1124(79)80152-5","article-title":"Comparative evaluation of the effect of a high yield criteria list upon skull radiography.","volume":"8","author":"Phillips","year":"1979"},{"key":"b26","series-title":"Neurosurgery","first-page":"221","article-title":"Disability caused by minor head injury.","volume":"9","author":"Rimel","year":"1981"},{"key":"b27","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1227\/00006123-198209000-00002","article-title":"Moderate head injury: completing the clinical spectrum of brain trauma.","volume":"11","author":"Rimel","year":"1982"},{"key":"b28","series-title":"Brain","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1093\/brain\/107.1.15","article-title":"Delayed deterioration following mild head injury in children.","volume":"107","author":"Snoek","year":"1984"},{"key":"b29","series-title":"Lancet","first-page":"480","article-title":"Assessment of coma and impaired consciousness. A practical scale.","volume":"1","author":"Teasdale","year":"1975"},{"key":"b30","series-title":"AJR","doi-asserted-by":"publisher","first-page":"661","DOI":"10.2214\/ajr.143.3.661","article-title":"Skull fracture and the low risk of intracranial sequelae in minor head trauma.","volume":"143","author":"Thornbury","year":"1984"},{"key":"b31","series-title":"Lancet","first-page":"369","article-title":"Were you knocked out?","volume":"1","author":"Totten","year":"1979"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/65\/2\/article-p203.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/65\/2\/article-p203.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/65\/2\/article-p203.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,24]],"date-time":"2022-07-24T15:34:40Z","timestamp":1658676880000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/65\/2\/article-p203.xml"}},"subtitle":["Assessment of risk in a series of 610 patients"],"short-title":[],"issued":{"date-parts":[[1986,8]]},"references-count":31,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/jns.1986.65.2.0203","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[1986,8]]}}}