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Prospective Study of Validity of Neurologic Signs in Predicting Positive Cranial Computed Tomography following Minor Head Trauma

Published online by Cambridge University Press:  28 June 2012

Yassir S. Abdul Rahman ,
Ahmed Sami S. Al Den  and
Kimball I. Maull
Yassir S. Abdul Rahman*
Affiliation:
The Trauma Center, Hamad General Hospital, Doha, Qatar
Ahmed Sami S. Al Den
Affiliation:
The Trauma Center, Hamad General Hospital, Doha, Qatar
Kimball I. Maull
Affiliation:
The Trauma Center, Hamad General Hospital, Doha, Qatar
*
Hamad General HospitalBox 3050Doha, Qatar E-mail: yasirsar@yahoo.com
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Abstract

Introduction:

The ability to discriminate among a large number of patients with mild head injury to detect those most likely to have an intracranial abnormality may offer an advantage in mass-casualty situations and when clinical needs exceed diagnostic capabilities.

Hypothesis:

In patients with mild head injury (Glasgow Coma Scale score = 13−15), the likelihood of intracranial abnormality, as defined by cranial computed tomography (CT), varies according to presenting neurologic signs and symptoms.

Methods:

This prospective study consisted of 152 patients with blunt head trauma and one or more of the following: initial loss of consciousness (LOC), headache, vomiting, convulsions, or amnesia. All underwent cranial CT within one hour of presentation. Positive CT findings were defined as cerebral contusion, extra-axial hematoma, intra-ventricular or subarachnoid hemorrhage, brain edema, and skull fracture. Clinical findings were tabulated and compared with CT findings.

Results:

The most common symptoms were headache (61%) followed by followed by LOC (45%), vomiting (39%), amnesia (29%), and convulsions (4%). Convulsions were the most predictive of a CT positive finding (80%); history of LOC was least predictive (29%). The presence of two or more clinical findings tended to increase the likelihood of intracranial abnormality, but the association was neither consistent nor additive.

Conclusions:

Convulsions occurring in a patient with mild head injury are highly predictive of a positive intracranial finding on CT. Headache, amnesia, and vomiting are each likely to show positive findings in approximately 40–45% of cases. Although the least predictive of the neurologic findings studied, loss of consciousness still correlates with a positive cranial CT in 29% of cases. More than one sign or symptom increases the likelihood of concurrent brain injury.

Keywords

amnesiaconvulsionhead computed tomography scanGlasgow Coma Scaleheadacheloss of consciousnessmild head traumavomiting
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 1 , February 2010 , pp. 59 - 62
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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