Document Detail

Utility of repeat head computed tomography in patients with an abnormal neurologic examination after minimal head injury.
MedLine Citation:
PMID:  21857258     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Previous studies proposed that repeat head computed tomography (RHCT) is of no value in patients with a minimal head injury (MHI) and normal neurologic examination (NE). The goal of our study was to investigate the value of RHCT in patients with MHI with an abnormal NE.
METHODS: A retrospective chart review of adult patients presenting to a Level I trauma center from July 2002 to December 2006 with MHI was performed. Demographics, injury severity, and HCT findings were collected. Patients with an abnormal NE at the time of RHCT were divided into three subgroups: acute deterioration NE (AD-NE), persistently abnormal NE (PA-NE), and unknown NE (U-NE). Changes in the management and outcomes after RHCT were compared.
RESULTS: One hundred seven patients had a MHI with an abnormal NE. Of those, seven (6.5%) had a change in management after RHCT. At the time of RHCT, 68 patients (63%) had a PA-NE, 21 AD-NE, and 18 U-NE. Six patients (29%) with AD-NE, 1 patient (6%) with an U-NE, and no patients with PA-NE required changes in management after RHCT. Compared with a RHCT, NE had higher positive and negative predictive values in determining the need for management changes.
CONCLUSIONS: Of all patients with MHI with an abnormal NE at the time of RHCT, 63% had a PA-NE. Although a RHCT is beneficial to patients with an acutely deteriorating or U-NE, it appears to be of little value in patients with a PA-NE. Compared with RHCT, serial NE may be a stronger predictor for the need for intervention in patients with MHI.
Ziad C Sifri; Natasha Nayak; Natasha Nyak; Adena T Homnick; Alicia A Mohr; Peter Yonclas; David H Livingston
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  71     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-23     Completed Date:  2012-02-14     Revised Date:  2012-03-22    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1605-10     Citation Subset:  AIM; IM    
Division of Trauma and Critical Care, Department of Surgery, UMDNJ-NJMS, Newark, New Jersey 07101, USA.
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MeSH Terms
Brain Injuries / mortality,  radiography*,  surgery*
Follow-Up Studies
Glasgow Coma Scale
Injury Severity Score
Middle Aged
Neurologic Examination / methods*
Neurosurgical Procedures / methods
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Survival Rate
Tomography, X-Ray Computed / utilization*
Trauma Centers
Treatment Outcome
Erratum In:
J Trauma. 2012 Feb;72(2):538
Note: Nyak, Natasha [corrected to Nayak, Natasha]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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