CLINICAL MANAGEMENT UPDATESScandinavian Guidelines for Initial Management of Minimal, Mild, and Moderate Head InjuriesIngebrigtsen, Tor MD, PhD; Romner, Bertil MD, PhD; Kock-Jensen, Carsten MDAuthor Information From the Norwegian Neurosurgical Society (T.I.), Norway, the Swedish Neurosurgical Society (B.R.), Sweden, and the Danish Neurosurgical Society (C.K.-J.), Denmark. Address for reprints: Tor Ingebrigtsen, MD, PhD, Department of Neurosurgery, University Hospital of Tromsø, N-9038 Tromsø, Norway; email: [email protected] Submitted for publication June 2, 1999. Accepted for publication January 3, 2000. The Bayer company supported the meetings of The Scandinavian Neurotrauma Committee (SNC) during the preparation of this paper. The Journal of Trauma: Injury, Infection, and Critical Care: April 2000 - Volume 48 - Issue 4 - p 760-766 Buy Abstract Background: The Scandinavian Neurotrauma Committee was initiated by the Scandinavian Neurosurgical Society to develop evidence-based guidelines for improved care of neurotrauma patients. Methods: A MEDLINE search identified 475 papers dealing with the management of minimal, mild, and moderate head injuries. Forty-two studies presenting class II evidence on the initial management of such injuries were reviewed and management guidelines were developed. Results: Implementation of the Head Injury Severity Scale is advocated. Patients with minimal injuries (no loss of consciousness, Glasgow Coma Scale score of 15) can be safely discharged. Routine early computed tomographic scan is recommended in cases with mild injuries (history of loss of consciousness, Glasgow Coma Scale score = 14–15) and patients with normal scans may be discharged. Computed tomographic scan and admission is mandatory in moderate injuries (Glasgow Coma Scale score = 13). All patients harboring additional risk factors should be scanned and admitted. A flow-chart for clinical decision making and a Head Injury Instruction card is introduced. Conclusions: The Scandinavian Neurotrauma Committee suggests guidelines that should be safe and cost-effective for the initial management of minimal, mild, and moderate head injuries. © 2000 Lippincott Williams & Wilkins, Inc.