|Prospective study of validity of neurologic signs in predicting positive cranial computed tomography following minor head trauma.|
|PMID: 20405463 Owner: NLM Status: MEDLINE|
|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.
|Yassir S Abdul Rahman; Ahmed Sami S Al Den; Kimball I Maull|
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|Type: Journal Article; Validation Studies|
|Title: Prehospital and disaster medicine Volume: 25 ISSN: 1049-023X ISO Abbreviation: Prehosp Disaster Med Publication Date: 2010 Jan-Feb|
|Created Date: 2010-04-20 Completed Date: 2011-01-11 Revised Date: 2011-12-15|
Medline Journal Info:
|Nlm Unique ID: 8918173 Medline TA: Prehosp Disaster Med Country: United States|
|Languages: eng Pagination: 59-62 Citation Subset: T|
|The Trauma Center, Hamad General Hospital, Doha, Qatar. firstname.lastname@example.org|
|APA/MLA Format Download EndNote Download BibTex|
Amnesia / etiology
Brain / physiopathology*
Brain Injuries / complications, diagnosis*, physiopathology
Craniocerebral Trauma / complications, diagnosis, physiopathology
Glasgow Coma Scale
Headache / etiology
Health Status Indicators
Injury Severity Score
Predictive Value of Tests
Seizures / etiology
Tomography, X-Ray Computed / instrumentation*
Unconsciousness / etiology
Vomiting / etiology
Wounds, Nonpenetrating / complications, diagnosis*, physiopathology
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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