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"In a very real sense, head injury is a social disease," says Russell Katz, M.D., deputy director of FDA's division of neuropharmacological drugs. "People drive drunk, don't use seat belts, shoot each other, or don't protect themselves with headgear in high-risk activities. If the social disease were 'treated,' then the head injury — the medical problem — would largely be prevented."

Common-sense measures to reduce head injuries are:

Wear a helmet when:

Riding a motorcycle. Riders without helmets increase their risk of head injury two to four times and their risk of death three to nine times.

Riding a bicycle. Bicyclists are at greater risk of head injury than motorcyclists — in part, because they tend to land on the head while motorcyclists usually hit another part of the body first. Head injury causes 75 percent of the approximately 1,000 bike-related deaths that occur each year, according to the May 1990 Consumer Reports. The report evaluated various brands of bike helmets, noting that helmets can prevent 85 percent of bicyclists' head injuries.

Performing other high-risk activities, such as construction work, boxing, football, and rock climbing.

Don't drink and drive.

Use seat belts and approved infant and child restraint seats in automobiles.

Keep infants and young children from open, unguarded windows.

Don't leave youngsters unattended in highchairs, strollers, buggies, or walkers.

Supervise children playing with projectile-type toys such as BB guns and archery sets.

Pay close attention when using nailing machines and power staplers. The force can drive a nail or staple through a thin wall or board, making it a flying missile that could pierce the skull.

Only use ladders in good condition. Match the length to the job, use stepladders opened, and prop straight or extension ladders against solid support. Face the ladder when using it.

If you're an older person, make your environment as safe as possible. Remove scatter rugs, use a slip-proof tub mat, ensure stairways are well-lit, keep outdoor steps and walks safe from snow and ice, and hold onto handrails at stairways and in the tub or shower.

Sidestep assault. If you jog in an isolated area, take along a partner. Keep the car doors locked. Instead of confronting a suspected burglar, leave the house and call the police from a neighbor's.

What About Skull X-Rays?

When it comes to diagnosing damage due to head injury, many physicians and most patients attach great importance to the detection of a skull fracture, says Philip M. McClean of FDA's Center for Devices and Radiological Health (CDRH).

"It's not unusual," he says, "for a physician to order an x-ray series because of pressure to do so by a parent or patient or because of fear of malpractice litigation."

But simple skull x-rays can't directly show intracranial injury because they don't depict the soft tissue. Further, McClean says, clinical studies show that without signs of nerve damage, discovery of a skull fracture usually doesn't affect treatment.

For these reasons, in 1979, CDRH convened a panel of experts representing family practice, pediatrics, neurological surgery, emergency medicine, and radiology to assess the value of skull x-rays following head injury and to develop a management strategy. McClean coordinated the study, which reviewed the records of more than 7,000 head injury patients. The findings were published in The New England Journal of Medicine, Jan. 8, 1987.

Among low-risk patients (those without symptoms or with only headache, dizziness, or a superficial scalp injury), the panel found that not a single intracranial injury had been discovered. They concluded that no such injury would have been missed by excluding skull x-rays for low-risk patients.

The panel recommended that low-risk patients be discharged under 48-hour observation by someone at home, as explained in a take-home instruction sheet. Typically, a "head" sheet lists symptoms requiring the patient's immediate return to the hospital, such as unusual drowsiness, confusion, persistent vomiting, blurred vision, neck stiffness, unrelenting headache, bleeding or fluid leakage from ears or nose, leg or arm weakness, convulsions, or unequal size of pupils.

The recommended strategy calls for withholding radiographic imaging unless additional symptoms develop. Should the physician deem the injury to be more than trivial despite the presence of solely low-risk criteria, the panel agreed patients may be reassigned as moderate risk or high risk, usually warranting computed tomography radiological examination, consultation with a neurosurgeon, and possibly supportive skull x-rays.

CDRH has made these criteria available to emergency departments throughout the country.

Tags: Health

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.