THE DIAGNOSTIC ALGORITHM AT HOSPITAL
On admission, verify whether the vital functions of the casualty have been ensured. Together with the emergency care physician identify trends in consciousness, breathing, and blood circulation. Also, assess the effect of therapy given prior to admission to hospital.
Examine the casualty for all possible extracranial injuries inferred from the mechanism of injury. Use the Champion Trauma Scale and the Glasgow Coma Scale. If the victim is in hypovolemic shock, injury to the abdomen and/or thorax should be taken into consideration. Determine whether you are dealing with single, associated or multiple trauma.
X-rays of the head, cervical spine, chest, pelvis or other organs are indicated depending on the mechanism of injury and clinical assessment. Scanning is performed if the vital functions are fully stabilized. The basic method for the diagnosis of TBI is computed tomography (CT). Urgent surgical treatment of life-threatening injuries to the chest, abdomen, or vessels is a priority to scanning.
For open head injuries associated with skull fractures head CT scan should
always be performed on admission. For closed head injuries, head CT scan is indicated
depending on the level of consciousness:
The diagnosis of cerebral concussion is established from history (head injury, transient loss of consciousness, retrograde amnesia). Neurological assessment is normal. Vegetative symptoms may be present. Close observation for at least 24 hours is recommended.
After ensuring the vital functions of the patient and determining TBI as single trauma, we perform a complete neurological assessment in ICU.
For casualties with severe brain injuries, we recommend that algosedation and skeletal muscle relaxation which has been established during pre-hospital care should not be discontinued immediately on admission because of possible intracranial hypertension.
Coordinated by Vit MARECEK, M.D.
Last updated: 2000-08-04