Predictors of important CT findings and neurosurgical intervention in minor head injury
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Date
2002-05
Authors
Ab. Latip, Laili Suriani
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Of all patients with head injury, minor head injury represents the most
common visitors of the emergency department. It contributed to about 70 - 80 o/o of all
head injury cases that are seen in the Accident and Emergency department. Minor head
injury is generally defined as those with history of blow to the head in which has resulted
in loss of consciousness and I or amnesia with Glasgow Coma Score of 13 to 15. It is
controversial whether cranial CT scan should be performed on all patients, as the yield of
positive CT scan is low as opposed to its high cost. The rate of neurosurgical intervention
is even lower to justify the routine use of CT scan on this patient. The use of clinical
variables as a screening tool before deciding to embark on CT scan is appropriate in order
to reduce the number of CT scan performed on all patients with minor head injury. The
clinical variables can than be used by the attending doctors in predicting important CT
findings and the need of neurosurgical intervention.
The aim of this study is to evaluate clinical variables that can
be used to predict important CT findings and the need of neurosurgical intervention
among patient who presented with minor head injury. A descriptive study was conducted
on 94 patients who had history of blow to the head, with Glasgow Coma Score of 13 to
15 and had cranial CT scan examination. There were a total of 15 clinical variables that were correlated with two outcomes. The outcomes were important CT findings and the
need of neurosurgical intervention. The predictors of important CT findings and the need
of neurosurgical intervention were derived after performing initial univariate analysis,
which was then followed by Multiple Logistic Regression.
There were a total of 94 retrospective and prospective patients with minor head
injury. 50 patients (53.2 %) had important CT findings and 19 patients (20.2 %) had
neurosurgical intervention. There were two significant predictors of important CT
findings. The presence of GCS score of 14 and 13 were associated with nearly 19-fold
increase in the risk of developing important CT findings compared to patients with full
GCS score. 3 out of 4 patients with GCS score of 14 or 13 developed clinically important
brain injury on CT scan examination. Similarly, the present of skull fracture was
associated with 56-time increase risk of developing important CT fmdings. 8 out of 10
patients with skull fracture developed clinically important CT fmdings. Mechanism of
injury was the only predictor of neurosurgical intervention. Non-motor vehicular accident
in which included pedestrian injury, fall from height, falling object, assault cases and
others were associated with four-fold increase risk of needing neurosurgical intervention.
Glasgow Coma Score of less of 15 and skull fractures were significant
clinical variables in predicting important CT findings in patients with minor head injury.
Therefore, proposal was made for reclassifying minor head injury in which it should be
based on the GCS score. Patients with full GCS score of 15 were classified as mild head
injury, while patients with GCS score of 13 and 14 were at higher risk of developing brain injury and therefore categorized as "high-risk mild head injury". Those patients
with skull fracture regardless of other clinical findings would automatically qualified the
patient into high-risk group. The high-risk group needed urgent cranial CT scan
examination. Particular mechanism of injury which included pedestrian injury, fall from
height, falling object and assaulted cases predisposed the patient for neurosurgical
intervention and therefore classified as high-risk mild head injury as well.
Description
Keywords
Head injury