To assess the incidence of head injury and predictors of complication across the care continuum.
Retrospective cohort study using data from a practice-based research network covering a population of > 30,000 patients.
We calculated the incidence of head injury in a longitudinal cohort covering 1-year interval (31,369 patient-years), and the incidence of complicated head injury in a longitudinal cohort covering 10 years interval (220,352 patient-years). Incidence rates were calculated per 1000 patient-years with 95% CI using the Mid-P exact test. We calculated ORs to assess potential risk factors for a complicated head injury.
The incidence of overall head injury was 22.1 per 1000 person-years and the incidence of a complicated course following head injury was 0.16 per 1000 person-years. The following determinants were risk factors for a complicated course: high energy trauma, bicycle accident, traffic accident in general, use of anticoagulants, alcohol intoxication, age above 60 years and low Glasgow Coma Scale at initial presentation. A complicated course was very unlikely when the first patients’ first encounter with a healthcare professional was in primary care (OR 0.03, 95%CI 0.01-0.07).
Complications after head injury are rarely seen in general practice. Patients who do experience complications are often easily identifiable as requiring specialist care. A more reserved referral policy for general practice may be desirable, suggesting that current guidelines are too defensive.
Conflict of interest and financial support: none declared.