Predictors of positive CT scans in the trauma patient with minor head injury.
Routine cerebral CT scanning of patients with minor head injuries has been advocated as a screening procedure for hospital admission. The purpose of this study was to determine whether there were characteristics of the trauma patient with a minor head injury. Glasgow Coma Scale (GCS) of 13-15, that would predict a positive cerebral CT scan. An analysis of 200 patients with potential head injuries transported to our regional trauma center was performed. The following characteristics were analyzed as possible predictors: scene GCS (SC-GCS), emergency room GCS (ER-GCS), a change in GCS from scene to emergency room, loss of consciousness (LOC), and focal neurological deficit. Forty-eight per cent (96/200) of the patients underwent CT scanning of the head. CT scans were positive in 4 per cent (8/200) of the total group and 8.3 per cent (8/96) of those who underwent CT scanning. In the patients without LOC and ER-GCS of 13-15, all CT scans were negative (95% confidence interval 0.0% to 3.4%). In the 93 patients with LOC, eight patients had a positive scan (P < 0.001). Of the nine patients who sustained a skull fracture, five had a positive CT (55.6%; 95% confidence interval 21.2% to 86.3%) (P < 0.0001). Of all the patients with positive CT scans, two underwent emergent craniotomy: one for a depressed skull fracture with underlying contusion, the other for a temporal bone fracture and an epidural hematoma. Both patients had LOC and SC-GCS and ER-GCS of 15.(ABSTRACT TRUNCATED AT 250 WORDS)
Moran
S G
SG
Department of Surgery, Wright State Univeristy School of Medicine, Dayton, Ohio.
McCarthy
M C
MC
Uddin
D E
DE
Poelstra
R J
RJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000601:surgery; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014218:Triage / Q000379:methods