HEAD INJURY

Course overview

Head injury is a significant high-risk area for healthcare practitioners. The medical literature indicates that there are over 750,000 Emergency Department visits for intracranial head injury each year. Medical errors and adverse outcomes related to traumatic brain injury (TBI) can result in profound permanent disability or death. TBI can be very difficult to diagnose and there remain questions and uncertainties regarding the optimal management of the head-injured patient. Practitioners must take the same risk-managed approach to each head-injured patient in order to take maximum advantage of the opportunity to identify TBI. In this activity, we provide head injury risk and documentation guidelines, review definitions and recommendations related to head injury, discuss the essentials of the neurologic examination, highlight the three groups of patients at highest risk for TBI, examine the issue of delayed intracranial injuries, and talk about the discharge of the head-injured patient. We present and discuss a number of cases to examine the common reasons for missed or delayed diagnosis, delayed or inappropriate management, or other causes of adverse outcomes and litigation related to head injury. After completing this activity, physicians should be able to: evaluate patients presenting with head trauma with an awareness of the reasons for the failure to diagnose TBI in order to improve patient safety, improve documentation and decrease the risk of exposure to medical malpractice; integrate the key clinical positives and negatives in the medical records of head-injured patients in order to demonstrate consideration of an appropriate differential diagnosis and decrease allegations of medical negligence; and apply current recommendations regarding the indications for head CT scanning for head-injured pediatric patients in order to determine when CT scans are necessary and when they can be avoided and improve the accuracy of diagnosing TBI.