title: Utility of repeat head computed tomography in patients with an abnormal neurologic examination after minimal head injury.
abstract: BACKGROUND
  Previous studies proposed that repeat head computed tomography (RHCT) is of no value in patients with a minimal head injury (MHI) and normal neurologic examination (NE). The goal of our study was to investigate the value of RHCT in patients with MHI with an abnormal NE.
  
  
  METHODS
  A retrospective chart review of adult patients presenting to a Level I trauma center from July 2002 to December 2006 with MHI was performed. Demographics, injury severity, and HCT findings were collected. Patients with an abnormal NE at the time of RHCT were divided into three subgroups: acute deterioration NE (AD-NE), persistently abnormal NE (PA-NE), and unknown NE (U-NE). Changes in the management and outcomes after RHCT were compared.
  
  
  RESULTS
  One hundred seven patients had a MHI with an abnormal NE. Of those, seven (6.5%) had a change in management after RHCT. At the time of RHCT, 68 patients (63%) had a PA-NE, 21 AD-NE, and 18 U-NE. Six patients (29%) with AD-NE, 1 patient (6%) with an U-NE, and no patients with PA-NE required changes in management after RHCT. Compared with a RHCT, NE had higher positive and negative predictive values in determining the need for management changes.
  
  
  CONCLUSIONS
  Of all patients with MHI with an abnormal NE at the time of RHCT, 63% had a PA-NE. Although a RHCT is beneficial to patients with an acutely deteriorating or U-NE, it appears to be of little value in patients with a PA-NE. Compared with RHCT, serial NE may be a stronger predictor for the need for intervention in patients with MHI.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, UMDNJ-NJMS, Newark, New Jersey 07101, USA. sifrizi@umdnj.edu
authors.forename: Ziad C
authors.initials: ZC
authors.lastname: Sifri
authors.forename: Natasha
authors.initials: N
authors.lastname: Nayak
authors.forename: Natasha
authors.initials: N
authors.lastname: Nyak
authors.forename: Adena T
authors.initials: AT
authors.lastname: Homnick
authors.forename: Alicia A
authors.initials: AA
authors.lastname: Mohr
authors.forename: Peter
authors.initials: P
authors.lastname: Yonclas
authors.forename: David H
authors.initials: DH
authors.lastname: Livingston
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014193:Trauma Centers; D016896:Treatment Outcome