title: Predictors of positive head CT scan and neurosurgical procedures after minor head trauma.
abstract: BACKGROUND
  There continues to be an ongoing debate regarding the utility of head CT scans in patients with a normal Glasgow Coma Scale (GCS) after minor head injury. The objective of this study is to determine patient and injury characteristics that predict a positive head CT scan or need for a neurosurgical procedure (NSP) among patients with blunt head injury and a normal GCS.
  
  
  METHODS
  Retrospective analysis of adult patients in the National Trauma Data Bank who presented to the ED with a history of blunt head injury and a normal GCS of 15. The primary outcomes were a positive head CT scan or a NSP. Multivariate logistic regression controlling for patient and injury characteristics was used to determine predictors of each outcome.
  
  
  RESULTS
  Out of a total of 83,566 patients, 24,414 (29.2%) had a positive head CT scan and 3476 (4.2%) underwent a NSP. Older patients and patients with a history of fall (compared with a motor vehicle crash) were more likely to have a positive finding on a head CT scan. Male patients, African-Americans (compared with Caucasians), and those who presented with a fall were more likely to have a NSP.
  
  
  CONCLUSIONS
  Older age, male gender, ethnicity, and mechanism of injury are significant predictors of a positive finding on head CT scans and the need for neurosurgical procedures. This study highlights patient and injury-specific characteristics that may help in identifying patients with supposedly minor head injury who will benefit from a head CT scan.
authors.affiliation: Center for Surgery Trials and Outcomes Research, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21212, USA.
authors.forename: Mehreen
authors.initials: M
authors.lastname: Kisat
authors.forename: Syed Nabeel
authors.initials: SN
authors.lastname: Zafar
authors.forename: Asad
authors.initials: A
authors.lastname: Latif
authors.forename: Cassandra V
authors.initials: CV
authors.lastname: Villegas
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
authors.forename: Kent A
authors.initials: KA
authors.lastname: Stevens
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Hasnain
authors.initials: H
authors.lastname: Zafar
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000601:surgery*; D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D044465:White People; D055815:Young Adult