Kisat M, Zafar SN, Latif A, Villegas CV, Efron DT, Stevens KA, Haut ER, Schneider EB, Zafar H, Haider AH. J. Surg. Res. 2012; 173(1): 31-37.
Affiliation
Center for Surgery Trials and Outcomes Research, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21212, USA.
BACKGROUND: There continues to be an ongoing debate regarding the utility of head CT scans in patients with a normal Glasgow Coma Scale (GCS) after minor head injury. The objective of this study is to determine patient and injury characteristics that predict a positive head CT scan or need for a neurosurgical procedure (NSP) among patients with blunt head injury and a normal GCS.
MATERIALS AND METHODS: Retrospective analysis of adult patients in the National Trauma Data Bank who presented to the ED with a history of blunt head injury and a normal GCS of 15. The primary outcomes were a positive head CT scan or a NSP. Multivariate logistic regression controlling for patient and injury characteristics was used to determine predictors of each outcome.
RESULTS: Out of a total of 83,566 patients, 24,414 (29.2%) had a positive head CT scan and 3476 (4.2%) underwent a NSP. Older patients and patients with a history of fall (compared with a motor vehicle crash) were more likely to have a positive finding on a head CT scan. Male patients, African-Americans (compared with Caucasians), and those who presented with a fall were more likely to have a NSP.
CONCLUSIONS: Older age, male gender, ethnicity, and mechanism of injury are significant predictors of a positive finding on head CT scans and the need for neurosurgical procedures. This study highlights patient and injury-specific characteristics that may help in identifying patients with supposedly minor head injury who will benefit from a head CT scan.