Original contributionClinical Decision Instruments for CT Scan in Minor Head Trauma
Introduction
Minor head injury is one of the most common injuries in the Western world, with an estimated incidence of 100 to 300 per 100,000 people (1). Minor head injury is commonly defined as blunt trauma to the head, after which the patient loses consciousness for <15 min or has a short, post-traumatic amnesia of <1 h, or both, as well as a normal or minimally altered mental status on presentation (a Glasgow Coma Scale [GCS] score of 13–15) (2). Intracranial complications of minor head injury are infrequent (6–21%) but potentially life-threatening, and may require neurosurgical intervention in a minority of cases (0.4–1.0%) (3).
In cases of head trauma, computed tomography (CT) scan is essential for all patients with a GCS score of 13 or less, whereas only a specific history, symptom, or physical examination finding makes CT scan necessary in patients with a GCS score of 15 or rising to 15 post-resuscitation. These findings, known as high-risk criteria, include: amnesia, loss of consciousness, vomiting, suspected skull fracture, a history of coagulopathy or anticoagulant use, focal neurological findings, post-traumatic seizures, severe or increasing headache, asymmetric pupils, or multiple trauma (4). Algorithms for the management of minor head injury have been proposed for these high-risk criteria (5).
Many studies have been conducted on this subject and algorithms developed with regard to the use of CT scan in patients with minor head trauma (6). The question still remains, however, whether all patients with a clinically significant lesion on CT scan really do require observation and, consequently, whether a CT scan is really indicated (3). Our study was performed to determine whether high-risk criteria represent a significant indication for initial CT scan in patients with minor head trauma, and whether or not analysis using delayed CT scan is necessary in patients with high-risk criteria before being discharged.
Section snippets
Methods
This study was conducted at the Karadeniz Technical University Emergency Department. After approval was obtained from the Local Ethical Committee, minor head injured patients presenting to the Emergency Department between September 1, 2003 and September 1, 2004 were evaluated prospectively. All patients presenting to the Emergency Department within 3 h of minor head trauma were included in the study, without regard to gender or age.
Minor head injury is defined as blunt trauma to the head, after
Results
Included in the study were 240 patients with minor head injury presenting to the Karadeniz Technical University Medical Faculty Emergency Department in the 1-year study period.
Initial CT scan was performed on all 240 patients investigated within the first 3 h. As a result of this initial CT scan, abnormal findings were identified in 47 (19%) patients overall. The number of patients with abnormal CT scan findings in the high-risk group was 39 (32%), and 8 (6%) in the low-risk group. Patients in
Discussion
The relevant literature contains many studies on the use of CT scan in patients with minor head injury, yet no consensus has been reached. A study by Haydel et al. suggested that CT scan is indicated only in patients with minor head injury with any one of seven risk factors, the New Orleans Criteria (7). According to this decision rule, patients without any risk factors would not require CT scan. A similar study by Stiell et al. identified a different set of factors, the Canadian CT Head Rule (8
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