title: Clinical predictors of abnormality disclosed by computed tomography after mild head trauma.
abstract: 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.
authors.affiliation: Department of Neurology, SUNY Health Science Center, Brooklyn.
authors.forename: J S
authors.initials: JS
authors.lastname: Jeret
authors.forename: M
authors.initials: M
authors.lastname: Mandell
authors.forename: B
authors.initials: B
authors.lastname: Anziska
authors.forename: M
authors.initials: M
authors.lastname: Lipitz
authors.forename: A P
authors.initials: AP
authors.lastname: Vilceus
authors.forename: J A
authors.initials: JA
authors.lastname: Ware
authors.forename: T A
authors.initials: TA
authors.lastname: Zesiewicz
mesh_terms: 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