Citation

Levitt MA, Cook LA, Simon BC, Williams V. Acad. Emerg. Med. 1995; 2(8): 675-680.

Affiliation

Highland General Hospital, Oakland, CA, USA.

Copyright

(Copyright © 1995, Society for Academic Emergency Medicine, Publisher John Wiley and Sons)

DOI

unavailable

PMID

7584744

Abstract

OBJECTIVE: To determine whether biochemical markers can selectively identify those intoxicated patients with presumed minor head injuries who are likely to have CT evidence of intracranial injury. METHODS: Patients presenting to the ED with simultaneous presumed minor head trauma and ethanol intoxication were prospectively entered into this cross-sectional study. Following phlebotomy, all patients received cranial CT. Associations between the presence of an abnormal CT scan for injury and serum levels of the following biochemical markers were sought: serum catecholamines, creatine kinase-brain band (CK-BB), and serum amylase. Serum levels are reported as mean +/- SEM. RESULTS: Nine of the 107 patients (8.4%; 95% CI 3.9-15.4%) had evidence of intracranial injury on CT. Mean serum CK-BB (16.1 +/- 3.7 vs 13.2 +/- 9.6 ng/mL), serum norepinephrine (913 +/- 117 vs 1,089 +/- 76 pg/mL), and serum amylase (64.9 +/- 14.8 vs 84 +/- 4.7 U/L) levels were not significantly different in patients with and without CT evidence of intracranial injury, respectively. Mean serum epinephrine (298 +/- 54 vs 167 +/- 18 pg/mL; p = 0.03) and serum dopamine (218 +/- 50 vs 130 +/- 9 pg/mL; p = 0.014) levels were significantly elevated in the group with intracranial injury on CT. A threshold level of serum dopamine > or = 140 pg/mL yields a sensitivity of 89% (95% CI 52-100%) and a specificity of 80% (95% CI 70-87%) for CT-evident injury. A threshold level of serum epinephrine > or = 218 pg/mL yields a sensitivity of 89% (95% CI 52-100%) and a specificity of 80% (95% CI 70-87%) for CT-evident injury. CONCLUSION: Elevated serum epinephrine and dopamine levels are associated with intracranial CT-evident injury for ethanol-intoxicated patients with presumed minor head injuries. The potential use of these biochemical markers to guide a more selective approach to cranial CT scanning warrants further evaluation.

Language: en