Assessment of the head injured patient in the Accident and Emergency (A & E) Department still poses a significant problem. Guidelines for skull radiography after apparently minor head injuries rely heavily on the degree o f scalp bruising and swelling present on examination. This in turn may be influenced by delay in presentation of the patient. Clearly a neurological examination is essential but some biomechanical factors may also have potential prognostic value in identifying the small number of patients who are at risk from developing complications.

This paper presents the results of a study of every head injured patient attending the Salford A & E service over a twelve month period. In addition to the more usual data concerning clinical status on arrival and outcome, consideration was given to the speed of impact and the object with which the head collided. The latter was then correlated with the severity of injury sustained. Severity has been classified by the state of consciousness on arrival, the period of post traumatic amnesia (PTA) and the presence of 3 skull fracture. The site of impact was also recorded and correlated with the duration of PTA.

“Sharp” hedd injuries were more frequently associated with local damage to the scalp whereas “blunt” injury produced longer PTA. Post traumatic amnesia was more commonly prolonged in those patients whose head injury was sustained without direct damage to the scalp. There was a positive association between speed of impact, duration of PTA and presence of skull fracture.

These results support Gennarelli’s hypothesis for cerebral concussion. The above mentioned biomechanical parameters have been used in the A & E department to redefine and safely restrict the indications for skull radiography.