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