CT positive brain injury in mild TBI patients presenting with normal SAC scores.
BACKGROUND
Traumatic brain injury accounts for over 1 million U.S. emergency department visits annually. A significant percentage of patients undergo CT scans to exclude intracranial bleeds. The Standardized Assessment of Concussion (SAC) is designed to rapidly determine whether a concussion has occurred, (0-30 scale, where ≥25 is considered normal). Although not intended to be used in isolation, results in the normal range are considered an indication of low suspicion of brain injury. This study evaluated the relationship between CT findings of structural injury (CT+) and performance on the SAC.


METHODS
We performed a prospective observational study on mild head-injured patients presenting to the emergency department who underwent CT scans and had SAC evaluations.


RESULTS
We enrolled 368 patients, of which 66 were read by a neuroradiologist as positive (CT+), with an average age of 46.7, and an average Glasgow Coma Scale of 14.85. 38.2% of these CT+ patients had a SAC score ≥25. There were no significant differences between time of injury and CT scan or SAC for those with high or low SAC scores. Both high and low SAC groups contained similar CT+ abnormalities (e.g., hematomas).


CONCLUSIONS
These results indicate that a normal SAC score alone does not exclude intracranial injury.
Department of Emergency Medicine, School of Medicine, Wayne State University, 4201 St. Antoine, University Health Center 6-G, Detroit, MI 48201.
Brian
B
O'Neil
Division of Emergency Medicine, Washington University School of Medicine, 660 So. Euclid, Box 8072, St. Louis, MO 63110.
Rosanne
R
Naunheim
Medical Corps, U.S. Army Institute for Surgical Research, Tactical Combat Casualty Care Research Program, 3698 Chambers Pass, Building 3611, Fort Sam Houston, TX 78234.
Robert
R
DeLorenzo
D000328:Adult; D000368:Aged; D001924:Brain Concussion / Q000000981:diagnostic imaging*; D001930:Brain Injuries / Q000000981:diagnostic imaging*; D020202:Cerebral Hemorrhage, Traumatic / Q000000981:diagnostic imaging; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D015599:Trauma Severity Indices; D055815:Young Adult