Head Injury

Key Features

Essentials of Diagnosis

• Grades of traumatic brain injury are traditionally defined by the Glasgow Coma Scale (GCS) measured 30 minutes after injury

• GCS Criteria used are eye opening, verbal response, and motor response

  • 1 Point

    • No eye opening

    • No verbal response

    • No motor response

  • 2 Points

    • Eyes open to pain

    • Patient vocal but not verbal

    • Extension motor response

  • 3 Points

    • Eyes open to voice

    • Patients verbal but not conversational

    • Flexion motor response

  • 4 Points

    • Eyes open spontaneously

    • Patient is conversational but disoriented

    • Patient withdraws from pain

  • 5 Points

    • Eyes open spontaneously

    • Patient is oriented in verbal response

    • Patient localizes pain

  • 6 Points

    • Eyes open spontaneously

    • Patient is oriented in verbal response

    • Obeys commands

  • Total GCS score indicates severity of TBI

    • Mild: 13–15

    • Moderate: 9–12

    • Severe: ≤ 8

General Considerations

• Trauma is the most common cause of death in young people, and head injury accounts for almost half of these trauma-related deaths

• Head injury severity ranges from concussion to severe TBI

• Concussion

  • Broadly defined as an alteration in mental status caused by trauma with or without loss of consciousness

  • The term is often used synonymously with mild TBI

• Head trauma may cause cerebral injury through a variety of mechanisms (Table 24–8)

• Central to management is determination of which patients need head imaging and observation