Prediction of intracranial computed tomography findings in patients with minor head injury by using logistic regression

Abstract

The decision rule developed by the authors appears to be 100% sensitive and 46% specific for positive findings on brain CT and will, in developing countries, help clarify the decision to obtain scans.

Two Different Approaches in Obtaining Head Computerized Tomography Scan in Minor Head Injuries

“…Many investigators agreed that age over 60 is significantly associated with acute abnormal CT [4,8,10,21,22,26,30,31]. Thus, it seems that advanced age patients need special attention and longer periods of observation.…”

“…Therefore, this group of patients was classified as high-risk mild head injury, and they were considered having the same risk as patients with a GCS score of 13 or 14 [11,21]. However, other investigators said that serious abnormal CT scan was acute lesion that needs for surgery [2,8,20,27]. Thus, not all acute abnormal CT was considered serious and not all abnormal CT scan should be identified and treated regardless of the need for surgery.…”

“…Teasdale firstly classified head injured patients with a GCS score of 15 as minor head injury [5]. Many other authors agree with this classification [6][7][8][9]. The separation between minor (GCS score of 15) and mild head injury (GCS score of 13 -14) is essential because the latter has significantly higher incidence of abnormal CT scan, the need for surgery and clinical deterioration [10][11][12][13][14][15].…”

Role of headache management in minor head injury before performing brain CT scan - can intravenous morphine sulfate predict intracranial injury?

“…[7] Moreover, precluding unnecessary CT scanning can significantly reduce health care expenditure [6] and resource use, as well as minimizing radiation exposure, [8] saving time, and preventing unnecessary transfer from centers that CT scan is not available. [9] On the other hand, there is an opposing opinion promoting a more liberal use of CT scan considering the unfavorable outcomes of missing an abnormality. The former is more dominant in a context that health policies emphasize on cost-effective use of resources or where resources are scarce and CT is not extensively available, whereas the latter is favored in a context that the fear of litigation is high.…”

“…[5] Several studies have assessed different indicators predicting abnormal CT scan, [10][11][12][13][14][15][16][17][18] and different criteria and guidelines have been developed for judicious utilization of CT scan aiming to reduce the number of unnecessary scans and at the same time not to jeopardize optimal patient care. [3,4,6,9,[19][20][21] The Canadian CT Head Rule (CCHR) [3] and the New Orleans Criteria (NOC) [6] are among the most widely studied decision rules. [8,[22][23][24][25][26][27] Headache is a very prevalent symptom in the victims of MHI.…”