A prospective evaluation of radiologic criteria for head injury patients in a community emergency department.
Several management strategies for radiographic evaluation of head-injury patients have been developed, most are based on retrospective analysis. The study attempted to prospectively evaluate the previously published Masters' criteria defining low-, medium-, and high-yield patients. A community hospital emergency department with a low prevalence of serious head injury was studied, and 1,000 consecutive patients 2 years of age presenting with historical or physical evidence of blunt head trauma were asked to participate; 967 consented. The patients were categorized by staff emergency physicians as low-, moderate-, and high-yield for intracranial injury on the basis of their initial history and physical examination. These categories guided imaging decisions in accordance with the guidelines of Masters. The patients were evaluated 6 weeks later by multiple questionnaire and/or telephone calls to determine whether or not undiagnosed head injuries had been missed. The 967 patients initially evaluated were classified according to their risk of intracranial injury as follows: 886 at low risk, 78 at moderate risk and 3 at high risk. Complete follow-up data were available for 895 of these patients (93%). Of the 895, 71 patients (7.9%) did report receiving follow-up medical care for their head injury; none had evidence of missed intracranial injury requiring intervention. Therefore, it can be inferred with a 95% confidence interval that 0.4% or less of patients who were diagnosed as not having intracranial injuries requiring intervention may actually have such injuries. The application of Masters' management strategy in low-risk populations permits clinicians to safely reduce the number of radiographs ordered for patients with head injury.
Richless
L K
LK
Department of Emergency Medicine, Citizens General Hospital, Pittsburgh, PA.
English
K
K
Heller
M B
MB
Rachlin
J
J
McClean
P
P
Auble
T E
TE
D001930:Brain Injuries / Q000000981:diagnostic imaging; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital; D006764:Hospitals, Community; D006801:Humans; D010414:Pennsylvania; D011446:Prospective Studies; D011859:Radiography / Q000592:standards; D012886:Skull / Q000000981:diagnostic imaging*; D012887:Skull Fractures / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed