Delayed Presentation after Head Injury: Is a Computed Tomography Scan Necessary?

Hemphill, Robin R.; Santen, Sally A.; Kleinschmidt, Paul E.

doi:10.1111/j.1553-2712.1999.tb01248.x

Cited by 10 publications

(14 citation statements)

References 30 publications

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“…25 Among the 821 cases with complications, we detected three confirmed cases of deterioration within 48 hours where an early CT had been normal. [26][27][28] The three cases-a man aged 74 years, a woman aged 31 years, and a boy aged 10 years-underwent their initial CT scan ''early'', three hours and four hours after injury (table 1). The repeated CT scans were performed after 23 hours, 21 hours, and 21 hours respectively, showing a subdural haematoma, an extradural haematoma, and intracranial bleeding respectively.…”

Section: Resultsmentioning

confidence: 99%

Mild head injury: reliability of early computed tomographic findings in triage for admission

Geijerstam

Britton²

2005

Emergency Medicine Journal

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Objective: To search the literature for case reports on adverse outcomes in patients with mild head injury where acute computed tomography (CT) findings had been normal. Methods: Mild head injury was defined as head trauma involving amnesia or loss of consciousness, but where neurological findings are normal on arrival at hospital (GCS 15). The scientific literature was systematically searched for case reports where an early CT was normal and the patient deteriorated within two days. In these cases, early discharge despite a normal CT head scan would have been hazardous. Results: Two prospective studies were found that investigated the safety of early CT in 3300 patients with mild head injury, as were 39 reports on adverse outcomes describing 821 patients. In addition, 52 studies containing over 62 000 patients with mild head injury were reviewed. In total, only three cases were deemed to have experienced an early adverse outcome despite a normal CT and GCS 15 on initial presentation. In another eight cases with incomplete descriptions, the interpretation was doubtful. Many reports of complications were not relevant to our question and excluded. These reports included cases with more severe head injury/not GCS 15 at presentation, complications that occurred after more than two days, or initial CT findings that were not fully normal. Conclusion: Very few cases were found where an early adverse event occurred after normal acute CT in patients with mild head injury. The strongest scientific evidence available at this time shows that a CT strategy is a safe way to triage patients for admission.

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Section: Resultsmentioning

confidence: 99%

Mild head injury: reliability of early computed tomographic findings in triage for admission

Geijerstam

Britton²

2005

Emergency Medicine Journal

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“…In a 1-month, follow-up study of 400 children with an initially normal CT scan examination and who were followed for 1 month post-injury, 4 children were readmitted and only 1 of these had an intracranial lesion (a subdural haematoma) requiring surgical intervention (12). In 1 case series of 194 patients examined at least 12 hours post-injury, 101 underwent a CT scan and 6 (3.3%) revealed an abnormality (57). Another case series describes the late deterioration due to diffuse brain swelling that might occur in children at varying time intervals after MTBI or trivial head injury (55).…”

Section: Delayed Intracranial Complicationsmentioning

confidence: 99%

Diagnostic procedures in mild traumatic brain injury: results of the who collaborating centre task force on mild traumatic brain injury

Borg

Holm²,

Cassidy³

et al. 2004

Journal of Rehabilitation Medicine

258

181

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We examined diagnostic procedures in mild traumatic brain injury by a systematic literature search. After screening 38,806 abstracts, we critically reviewed 228 diagnostic studies and accepted 73 (32%). The estimated prevalence of intracranial CT scan abnormalities is 5% in patients presenting to hospital with a Glasgow Coma Scale score of 15 and 30% or higher in patients presenting with a score of 13. About 1% of all treated patients with mild traumatic brain injury require neurosurgical intervention. There is strong evidence that clinical factors can predict computerized tomography scan abnormalities and the need for intervention in adults, but no such evidence for mild traumatic brain injury in children. We found evidence that skull fracture is a risk factor for intracranial lesions, but the diagnostic accuracy of radiologically diagnosed skull fracture as an indication of intracranial lesions is poor. There is only a little evidence for the diagnostic validity of cognitive testing and other diagnostic tools for mild traumatic brain injury.

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“…Minor head injury was defined as loss of consciousness or amnesia in many studies, 3,13,15,16,19,21,23,24,28,35,40,44,[61][62][63]66,67 but not specified in many others. 11,14,26,27,[29][30][31]33,34,39,41,[46][47][48][49]64,65 Patients were included with unspecified GCS scores in some studies, 11,15,30,31,33,34,39,46,47,49,65 and in others were included with GCS scores of 15, 14,16,40,48,61,6...…”

Section: E T H O D O L O G I C S T a N D A R D S F O R D E C I S I mentioning

confidence: 99%

“…14,33,44,62 Approximately half of the studies only considered patients who had been admitted to the hospital. 9,13,15,16,19,21,23,24,27,28,33,44,46,48,49,62,63 Very few studies specified whether patients should be excluded on the basis of penetrating injury, 24,[29][30][31]35,40,41 presence of skull fracture, 16,27,44 time since the injury, 19,30,40,64,66,67 timing of the GCS examination, 13,19,21,23,24,48 presence of neurologic deficit, 15,19,21,24,27,38 ethanol intoxication (no studies), associated injuries,…”

Section: E T H O D O L O G I C S T a N D A R D S F O R D E C I S I mentioning

confidence: 99%

“…Many studies had small sample sizes with fewer than 500 patients with minor head injury. 15,16,23,24,[26][27][28][29][30]39,41,44,48,49,64,66 The mathematical techniques were described in only some studies 3,11,14,[29][30][31][33][34][35]41,46,[62][63][64][65][66] and were generally rudimentary; very few included multivariate analyses. Very few studies concluded with clear, simple guidelines that could be described as clinically sensible.…”

Section: E T H O D O L O G I C S T a N D A R D S F O R D E C I S I mentioning

confidence: 99%

See 1 more Smart Citation

The canadian CT head rule study for patients with minor head injury: Rationale, objectives, and methodology for phase I (derivation)

Stiell

Lesiuk²,

Wells

et al. 2001

Annals of Emergency Medicine

105

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Delayed Presentation after Head Injury: Is a Computed Tomography Scan Necessary?

Cited by 10 publications

References 30 publications

Mild head injury: reliability of early computed tomographic findings in triage for admission

Mild head injury: reliability of early computed tomographic findings in triage for admission

Diagnostic procedures in mild traumatic brain injury: results of the who collaborating centre task force on mild traumatic brain injury

The canadian CT head rule study for patients with minor head injury: Rationale, objectives, and methodology for phase I (derivation)

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