Computed Tomography Profile and its Utilization in Head Injury Patients in Emergency Department: A Prospective Observational Study

Abstract

Context:Based on Glasgow Coma Scale (GCS), head injury can be classified as minor (GCS 13–15), moderate (GCS 9–12), and severe (GCS 3–8). There is a lot of controversy in the use of computed tomography (CT) in head injury patients.Aims:This study was intended to estimate the rate of CT positivity in head injury patients and to define the criteria for doing CT in head injury patients.Settings and Design:This was a prospective observational study in the emergency department (ED) over a 12-month period. Subjects andMethods:Study involved all head injury patients attending ED. Risk factors studied were a loss of consciousness (LOC), vomiting, seizures, ear bleed, nosebleed, external injuries, and alcohol intoxication.Statistical Analysis Used:Comparison of CT positivity with the patient's demographics and clinical characteristics was carried out using Chi-square.Results:A total of 1782 patients were included in this study. Overall CT positivity was 50.9%. In minor head injury (MHI), CT positivity rate was 38%. The study showed significant association of CT positivity with five variables: LOC >5 min, vomiting, seizures, ear bleed, and nosebleed.Conclusions:From the study, we recommend following: CT is indicated in all patients with moderate and severe head injury (GCS ≤12). Low threshold for taking CT is advisable in elderly and alcohol-intoxicated patients. In MHI, CT is indicated if any one of the following risk factors are present: LOC >5 min, history of vomiting, history of seizures, history of ear bleed, and history of nosebleed.

Computed tomographic imaging appraisal of traumatic brain injury in a tertiary hospital in South-South Nigeria: A 6-year review

“…These primary injuries include intracranial hemorrhages, contusion, traumatic axonal injuries, scalp injuries, and fractures. 2 5 11 Detection of the latter, especially when involving the base of the skull, is the significant feature of CT. This is further facilitated with the exploit of bone algorithm CT or three-dimensional (3D) volumetric CT. CT, therefore, has become the consensus choice as it has a rapid imaging time, high sensitivity for calvarial fracture detection, and high potential for the detection of lodged radiopaque foreign bodies.…”

Correlation of Glasgow Coma Scale (GCS) with Computed Tomography (CT) in Patients of Intra-Cranial Injuries

“…Low threshold for taking CT is advisable in elderly and alcohol-intoxicated patients. In mild head injury, CT has indicated if any one of the following risk factors is present: loss of consciousness (LOC >5 min), history of vomiting, history of seizures, history of ear bleed, and history of nosebleed 10 .…”

Whats New in Emergencies, Trauma and Shock? Computed Tomography Profile and its Utilization in Traumatic Brain Injury

“…The present study examines the role of computed tomography (CT) scan in patients with traumatic brain injury and discusses the demographic details, injury distribution, intracranial imaging findings, and identifies the risk factors to request a CT scan in patients with suspected traumatic brain injury (TBI). [ 1 ] It is beyond doubt that the CT is rapid, widely available, and one of the most valuable imaging modality to investigate patients with TBI in the emergency department. [ 2 ] The use of CT scan in the emergency department has been progressively increasing[ 3 4 5 6 ] which not only has the potential to increase the cost of care[ 7 8 ] but also the increased radiation exposure can lead to a harmful sequel.…”

“…[ 3 9 10 11 ] This study clearly identifies that CT is indicated in all patients with moderate and severe head injury (Glasgow Coma Scale ≤12), and there should be low threshold for asking a CT scan in elderly and in patients who are under influence of alcohol. [ 1 ]…”

“…In this study, the authors have found that in patients with minor head injury, there was strong association between CT scan positivity rate and the history of loss of consciousness of >5 min, history of vomiting, seizures, ear bleed, and/or nasal bleed. [ 1 ] Out of 1782 patients, 1341 patients were investigated for minor head injury, and only 38% of patients had a positive-CT scan with different pathologies and variable extent of intracranial lesions (might or might not had required neurosurgical intervention). The authors rightly point that the use of clinical predictors in patients with TBI may help to reduce unnecessary CT scans by a significant number.…”