Analysis of the reliability of clinical examination in predicting traumatic cerebral lesions and skull fractures in patients with mild and moderate head trauma.
The aim of the study was to assess the reliability of neurological examination and other factors in predicting traumatic cerebral lesions and skull fractures in patients with mild and moderate head trauma (GCS 10-15).


METHODS
Over a one-year period, 227 patients: 145 male and 82 female, aged a mean of 51 years who sustained mild or moderate head trauma (GSC 10-15) were examined neurologically and had performed head CT scans. The neurological examination as a whole and each finding of the neurological examination were tested as predictors of the presence of traumatic abnormalities in the head CT scan.


RESULTS
Post-traumatic lesions in head CT scan were found in 109 patients (48%): skull fractures in 66 of these and brain injuries in 94; fifty-eight patients had skull fracture combined with brain injury. Seventeen patients required neurosurgical intervention (hematoma evacuation). Abnormal neurological examination showed the highest reliability in identifying patients with brain injuries in CT (sensitivity 87%, specificity 79%). Of single findings, gait abnormalities and consciousness disturbances, present in sober patients, were the strongest predictors of cerebral lesions. Likewise, abnormal neurological examination was the best indicator of skull fractures (sensitivity 77%, specificity 63%). Gait abnormalities and "raccoon eyes" present in alcohol intoxicated patients were the strongest individual predictors of skull fractures.


CONCLUSIONS
Results of our study show neurological abnormalities as the most reliable (although not 100% accurate) in identifying patients who are likely to have brain injuries and/or skull fracture following head trauma. Use of clinical decision rules may reduce the number of head CT scans performed "just in case".
Andrzej
A
Zyluk
Agnieszka
A
Mazur
Bernard
B
Piotuch
Krzysztof
K
Safranow
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000175:diagnosis* / Q000209:etiology; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012887:Skull Fractures / Q000175:diagnosis* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D055815:Young Adult