Scientific paper
Value of repeat cranial computed axial tomography scanning in patients with minimal head injury

Presented at the 32nd Annual Meeting of the Western Trauma Association, Whistler–Blackcombe, British Colombia, Canada, February 24 to March 1, 2002
https://doi.org/10.1016/j.amjsurg.2003.12.015Get rights and content

Abstract

Background

Patients with minimal head injury (MHI) and a cranial computed axial tomography (CAT) scan positive for the presence of intracranial injury routinely undergo a repeat CAT scan within 24 hours after injury. The value of this repeat cranial CAT scan is unclear in those patients who are neurologically normal or improving.

Methods

A retrospective analysis of all adult patients admitted to a level-1 trauma center with MHI and a positive cranial CAT scan during a 32-month period was performed. The need for neurosurgical intervention after repeat CAT scan in patients with a persistently normal or improved neurological examination was recorded.

Results

One hundred fifty-one patients had a persistently normal or improved neurological examination, but none of these patients required neurosurgical intervention after the repeat cranial CAT scan.

Conclusions

A persistently normal or improving neurological examination in a patient with MHI appears to exclude the need for neurosurgical intervention and thus a repeat cranial CAT scan.

Section snippets

Methods

All blunt trauma patients ≥16 years of age admitted to a level-1 trauma center between January 1999 and August 2001 and who sustained MHI and had a cranial CAT scan positive for intracranial injury were identified in the trauma registry. MHI was defined as a head injury resulting in either a loss of consciousness and/or posttraumatic amnesia associated with a Glasgow Coma Score (GCS) of 14 or 15 [2]. Patients were excluded if they had a history of brain injury or coagulopathy. Coagulopathy was

Results

Of the patients, 1,596 were identified as having sustained MHI during the 32-month study period. Of those, 243 patients (15%) had evidence of intracranial injury on initial cranial CAT scan. Sixteen patients were excluded because of a history of brain injury [10] or coagulopathy [6]. After the initial cranial CAT scan was performed, seven patients (3%) required an immediate neurosurgical intervention (emergent craniotomy in five and insertion of an ICP monitor in two patients). Eighteen

Comments

The value of cranial CAT scanning in patients after MHI has been unequivocally demonstrated in prospective studies and is considered the standard of care [2], [3], [4], [5]. Patients who sustain MHI with no evidence of intracranial injury on cranial CAT scan and who have no persistent neurological findings can be safely discharged from the ED [3], [6], [7], [11]. However, the optimal management of patients who sustain MHI with evidence of intracranial injury on cranial CAT scan is uncertain.

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