Document Detail


Prospective study of validity of neurologic signs in predicting positive cranial computed tomography following minor head trauma.
MedLine Citation:
PMID:  20405463     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Yassir S Abdul Rahman; Ahmed Sami S Al Den; Kimball I Maull
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Publication Detail:
Type:  Journal Article; Validation Studies    
Journal Detail:
Title:  Prehospital and disaster medicine     Volume:  25     ISSN:  1049-023X     ISO Abbreviation:  Prehosp Disaster Med     Publication Date:    2010 Jan-Feb
Date Detail:
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    
Other Details:
Languages:  eng     Pagination:  59-62     Citation Subset:  T    
Affiliation:
The Trauma Center, Hamad General Hospital, Doha, Qatar. yasirsar@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Amnesia / etiology
Brain / physiopathology*
Brain Injuries / complications,  diagnosis*,  physiopathology
Child
Child, Preschool
Craniocerebral Trauma / complications,  diagnosis,  physiopathology
Female
Glasgow Coma Scale
Headache / etiology
Health Status Indicators
Humans
Infant
Infant, Newborn
Injury Severity Score
Male
Middle Aged
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Factors
Seizures / etiology
Tomography, X-Ray Computed / instrumentation*
Unconsciousness / etiology
Vomiting / etiology
Wounds, Nonpenetrating / complications,  diagnosis*,  physiopathology
Young Adult

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