Head Injury Stitches: Tetanus Shot and Follow-Up Care Considerations

Head wound suturing?

Hello Dr.
Lee: My wife accidentally hit her head with a pot while abroad (in Cambodia) and received three stitches at the hospital, but she did not receive a tetanus shot.
I would like to ask if she needs to get a tetanus shot and a CT scan when she returns to Taiwan, considering the pot was not rusty.
She will be returning to Taiwan in about 20 days.
If we wait until she returns to have a head examination, will it still be possible to detect any issues? If the wound heals, will there be any long-term effects?

Ding Xiansheng, 30~39 year old female. Ask Date: 2015/10/13

Dr. Li Zhonghuai reply Surgery

Hello! If you haven't received a tetanus shot in the past six months, it is recommended to get one.
If more than 24 hours have passed since the injury and you have no discomfort, you can just observe.
For head injuries, the decision to perform a CT scan depends on the severity of the injury.
Generally, if injured by a pot, observation is sufficient.
The hospital will provide a head injury discharge instruction, advising that if you experience severe pain, confusion, or other sudden symptoms, you should return to the emergency department for a follow-up CT scan.
For head contusions, aside from occasional sharp pain within three to six months, there are usually no long-term effects.
However, it is common to experience headaches and dizziness occasionally within six months.

Reply Date: 2015/10/13

More Info

When it comes to head injuries, especially those requiring stitches, there are several important considerations regarding follow-up care, potential complications, and the need for vaccinations such as the tetanus shot.
First and foremost, it is crucial to assess the nature of the injury. Since your wife sustained a head injury from a pot, the first step is to ensure that the wound is clean and properly cared for to prevent infection. If the pot was not rusty and the injury was not caused by a contaminated object, the risk of tetanus is relatively low. However, the Centers for Disease Control and Prevention (CDC) recommends that adults receive a tetanus booster every ten years, or every five years if the injury is particularly dirty or severe. Given that your wife did not receive a tetanus shot at the time of her injury, it would be advisable for her to consult with a healthcare provider upon her return to Taiwan to determine if a booster is necessary, especially if it has been more than five years since her last shot.

Regarding the need for a CT scan, it depends on the symptoms she may be experiencing. If she has any signs of complications such as persistent headache, confusion, dizziness, nausea, vomiting, or any neurological symptoms (like weakness or numbness), a CT scan would be warranted to rule out any intracranial injuries or bleeding. If she is asymptomatic and the wound appears to be healing well, it may not be necessary to perform a CT scan immediately. However, it is always best to err on the side of caution, especially with head injuries.

As for the timeline of 20 days before returning to Taiwan, if she is symptom-free and the wound is healing properly, it is generally safe to wait until she returns for a follow-up examination. However, if any concerning symptoms arise during this time, she should seek medical attention immediately, regardless of her location.

Concerning the potential for long-term effects or sequelae from the injury, this largely depends on the severity of the injury and whether there was any damage to the underlying structures of the head, such as the skull or brain. Most minor head injuries heal without complications, but some individuals may experience lingering symptoms such as headaches, dizziness, or cognitive difficulties. These symptoms can sometimes be related to post-concussion syndrome, which can occur after a mild traumatic brain injury. If your wife experiences any persistent symptoms after her injury, it would be wise for her to consult a neurologist or a specialist in brain injuries for further evaluation and management.

In summary, upon your wife's return to Taiwan, she should consider getting a tetanus booster if it has been more than five years since her last shot, especially since she did not receive one after her injury. A CT scan may be necessary if she exhibits any concerning symptoms. While most minor head injuries heal without long-term effects, monitoring for any persistent symptoms is essential. Regular follow-up with healthcare providers will ensure that any potential complications are addressed promptly.

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