Clinical predictors of abnormality disclosed by computed tomography after mild head trauma.
We prospectively studied 712 consecutive patients during a 1-year period who presented with amnesia or loss of consciousness after nonpenetrating head trauma and who had a perfect Glasgow Coma Scale score of 15. Of the 67 (9.4%) patients with acute traumatic lesions disclosed by computed tomography (CT) of the head, 2 required neurosurgical intervention and 1 died. Four factors were statistically correlated (P < 0.05) with abnormal CT findings: Older age, white race, signs of basilar skull fracture, and being either a pedestrian hit by a motor vehicle or a victim of an assault. Sex, length of antero- or retrograde amnesia, forward and reverse digit spans, object recall, focal abnormality on the general neurological exam, and subjective complaints were not statistically correlated with CT abnormality. Using step-wise discriminant function analysis, no single item or combination of items could be used to classify 95% of the patients into either the normal or abnormal CT group. Therefore, regardless of age, mechanism of injury, or clinical findings, intracranial lesions cannot be completely excluded clinically on head-trauma patients who have loss of consciousness or amnesia, even if the Glasgow Coma Scale score is 15. However, only two patients (0.3%) required neurosurgical intervention.
Jeret
J S
JS
Department of Neurology, SUNY Health Science Center, Brooklyn.
Mandell
M
M
Anziska
B
B
Lipitz
M
M
Vilceus
A P
AP
Ware
J A
JA
Zesiewicz
T A
TA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001924:Brain Concussion / Q000000981:diagnostic imaging / Q000601:surgery; D001925:Brain Damage, Chronic / Q000000981:diagnostic imaging / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D014057:Tomography, X-Ray Computed