Value of Skull Radiography, Head Computed Tomographic Scanning, and Admission for Observation in Cases of Minor Head Injury

Abstract

A retrospective review of 373 adult patients admitted to Harbor General Hospital between 1980 and 1984 for minor closed head injury (Glasgow coma scale 13-15) was performed to determine the benefits of skull radiography, computed tomographic (CT) scanning of the head, and admission for observation. Variables reviewed were mental status, neurological examination, presence or absence of loss of consciousness, clinical evidence of basilar skull fracture, and fracture on skull radiography. The neurological examination (including mental status and Glasgow coma scale) in the emergency room was the best predictor of subsequent deterioration or the presence of an operative hematoma. The only patients with Glasgow coma scale scores of 15 who required surgical evacuation of an extraaxial hematoma had focal neurological deficits referable to hemispheric compression, with or without an abnormal mental status. A Glasgow coma scale score of 13 or 14 places the patient at risk either of having a hematoma requiring surgery or of deteriorating. We recommend that a head CT scan be obtained on all patients with Glasgow coma scale scores of less than 15, abnormal mental status, or hemispheric neurological deficits. If no operative lesion is found on the CT scan, the patient should be admitted for observation because there is still a risk of deterioration. Those with a Glasgow coma scale score of 15, a normal mental status, and no hemispheric neurological deficit may be discharged to be observed at home by a competent observer despite basilar or calvarial skull fracture, loss of consciousness, or cranial nerve deficit. No benefit was gained from skull radiography in any group.

CT scan findings in mild head trauma: a series of 2,000 patients

“…, and our study found a number between these extremes (7.5%). We had a lower frequency of pneumocephalus (1.5%), when compared to Shackford 6 (5.4%) and Feuerman et al (13.2%) 36 .…”

Motor Vehicle Crash-Related Subdural Hematoma from Real-World Head Impact Data

“…Although fractures were only observed in 17 of the occupants, these data support reported findings that skull fractures increase the risk of TBI. [32][33][34][35] However, no studies have directly addressed the relationship between increased injury volume and fracture incidence.…”

Minor Head Trauma in Anticoagulated Patients

“…1 -13 However, there is convincing evidence that in the absence of LOC and neurologic abnormality, a CT scan of the head is unnecessary and may be omitted from the evaluation unless otherwise clinically indicated. 4,11,13 A patient maintained on oral anticoagulants is assessed differently. Several studies have demonstrated that conventional intensities of anticoagulation are associated with a seven-to tenfold risk of spontaneous ICH.…”

“…1 -5,7 -9,11,12 However, in the absence of LOC and with a normal neurologic examination in the ED, several authors have concluded that CT scanning is unnecessary and such patients may be safely discharged to home. 4,11,13 To our knowledge, there is no literature referring to the evaluation of the anticoagulated patient taking warfarin who suffers minor head trauma. Retrospective studies of hemophiliacs sustaining minor head trauma without LOC and having a normal neurologic examination have demonstrated that CT scanning of the head is unremarkable.…”