Indications for Computed Tomography in Patients With Mild Head Injury

Abstract

The factors affecting outcome were analyzed in 1,064 patients, 621 males and 443 females aged 10 to 104 years (mean 46 ± 23 years), with mild head injury (Glasgow Coma Scale [GCS] score AE14) but no neurological signs presenting within 6 hours after injury. Intracranial lesion was found in 4.7% (50/1,064), and 0.66% (7/1,064) required surgical treatment. The Japan Coma Scale (JCS) and GCS assessments were well correlated (r ＝ 0.797). Multivariate analysis revealed significant correlations between computed tomography (CT) abnormality and age AE60 years, male sex, JCS score AE1, alcohol consumption, headache, nausea/vomiting, and transient loss of consciousness (LOC)/amnesia. Univariate analysis revealed that pedestrian in a motor vehicle accident, falling from height, and mechanisms of injuries except blows were correlated to intracranial injury. No significant correlations were found between craniofacial soft tissue injury and intracranial injury. Patients with occipital impact, nonfrontal impact, or skull fracture were more likely have intracranial lesions. Bleeding tendency was not correlated with CT abnormality. The following indications were proposed for CT: JCS score À0, presence of accessory symptoms (headache, nausea/vomiting, LOC/amnesia), and age AE60 years. These criteria would reduce the frequency of CT by 29% (309/1,064). Applying these indications to subsequent patients with GCS scores 14-15, 114 of 168 patients required CT, and intracranial lesions were found in 13. Two refused CT. Fifty-four of the 168 patients did not need CT according to the indications, but 38 of the 54 patients actually underwent CT because of social reasons (n ＝ 21) or patient request (n ＝ 17). These indications for CT including JCS may be useful in the management of patients with mild head injury.

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

“…The design and patient characteristics of the 19 studies (representing 22 articles) 26,27,29,46,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] that evaluated the diagnostic performance of clinical decision rules for identifying ICI or need for neurosurgery in adults with MHI are summarised in Table 2. Eight studies were from the USA, 27,29,55,58,59,61,62,64 two each from Italy, 54,57,71 Canada 26,46 and the Islamic Republic of Iran, 66,67 and one each from the Netherlands, [68][69][70] Australia, 65 Japan, 63 Spain 60 and Denmark.…”

“…Eight studies were from the USA, 27,29,55,58,59,61,62,64 two each from Italy, 54,57,71 Canada 26,46 and the Islamic Republic of Iran, 66,67 and one each from the Netherlands, [68][69][70] Australia, 65 Japan, 63 Spain 60 and Denmark. 56 Six were multicentre studies.…”

“…56 Six were multicentre studies. 26,46,62,[66][67][68][69][70] Cohorts ranged in size from 168 63 to 13,728. 62 Fourteen studies derived a new rule.…”

“…26,27,29,[54][55][56]60,[61][62][63][64]66,67,69 Four studies 46,57,60,[68][69][70][71] reported validation results for more than one rule in the same cohort. Data were collected prospectively in 15 studies, 26,27,29,46,[56][57][58][59][60][61][62][63][66][67][68][69][70][71] of which participants were recruited consecutively in 13, 26,27,29,[56][57][58][59][60]62,63,[66][...…”

Role of headache management in minor head injury before performing brain CT scan - can intravenous morphine sulfate predict intracranial injury?

“…The former is more dominant in a context that health policies emphasize on cost-effective use of resources or where resources are scarce and CT is not extensively available, whereas the latter is favored in a context that the fear of litigation is high. [5] Several studies have assessed different indicators predicting abnormal CT scan, [10][11][12][13][14][15][16][17][18] and different criteria and guidelines have been developed for judicious utilization of CT scan aiming to reduce the number of unnecessary scans and at the same time not to jeopardize optimal patient care. [3,4,6,9,[19][20][21] The Canadian CT Head Rule (CCHR) [3] and the New Orleans Criteria (NOC) [6] are among the most widely studied decision rules.…”