Document Detail

Loss of consciousness: when to perform computed tomography?
MedLine Citation:
PMID:  15115559     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the diagnostic value of physical examination (including neurologic exam) for positive computed tomography scan findings in children with closed head injury, Glasgow Coma Scale score 13-15 in the emergency department, and loss of consciousness or amnesia. DESIGN: Prospective descriptive study. SETTING: A large, tertiary, pediatric trauma center in San Diego County. PATIENTS: Children ages 2-16 with an isolated closed head injury, history of loss of consciousness or amnesia, and Glasgow Coma Scale 13-15 who were referred for pediatric trauma evaluation and received a head computed tomography as part of this evaluation. INTERVENTIONS: A standardized physical examination including skull/scalp exam, pupils, tympanic membrane, and brief neurologic exam was documented on each patient. MEASUREMENTS AND MAIN RESULTS: Subjects age 2-16 being evaluated by the pediatric trauma team for closed head injury with loss of consciousness or amnesia and Glasgow Coma Scale 13-15 received a standardized physical exam, noncontrast head computed tomography scan, and follow-up telephone call at 4-6 wks. Outcome variables include intracranial injury visualized on computed tomography scan and need for neurosurgical intervention. Ninety-eight subjects were enrolled in the study over a 1-yr period. Computed tomography scans revealed evidence of intracranial injury in 13 of 98 subjects (13%). Normal examination increased the probability of a normal computed tomography scan from.87 pretest to.90 posttest. Four of 38 subjects with normal examination were noted to have evidence of intracranial injury on computed tomography. These four subjects did not require neurosurgical intervention. Two of 98 subjects underwent neurosurgical procedures. One intracranial pressure monitor was placed for decreasing level of consciousness. One subject underwent surgical elevation of a depressed skull fracture. CONCLUSIONS: Detailed clinical examination is of no diagnostic value in detecting intracranial injuries found on head computed tomography scan. Patients with observed loss of consciousness or amnesia and Glasgow Coma Scale 13-15 should have a head computed tomography scan as part of their evaluation to avoid missing an intracranial injury.
Michelle K Halley; Patricia D Silva; Jennifer Foley; Alexander Rodarte
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  5     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-04-29     Completed Date:  2004-10-19     Revised Date:  2005-07-14    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  230-3     Citation Subset:  IM    
Children's Hospital and Health Center, San Diego, CA 92123, USA.
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MeSH Terms
Amnesia / etiology,  radiography*
Brain / radiography*
Brain Injuries / diagnosis*,  etiology
Child, Preschool
Emergency Service, Hospital
Glasgow Coma Scale
Head Injuries, Closed / complications,  radiography
Neurologic Examination
Predictive Value of Tests
Prospective Studies
Tomography, X-Ray Computed
Unconsciousness / etiology,  radiography*
Comment In:
Pediatr Crit Care Med. 2005 Jan;6(1):93-4   [PMID:  15643308 ]
Pediatr Crit Care Med. 2004 May;5(3):293-4   [PMID:  15167713 ]

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