The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries

Steven R. Shackford, Steven L. Wald, Steven E. Ross, Thomas H. Cogbill, David B. Hoyt, John A. Morris, Peter A. Mucha, H. Leon Pachter, Harvey J. Sugerman, Keith F. O'Malley, Pamela J. Strutt, Robert J. Winchell, Edmund Rutherford, Michael Rhodes, Max Koslow, Eric J. Demaria

Research output: Contribution to journalArticle

230 Citations (Scopus)

Abstract

The evaluation and management of patients with minor head injury (MHI: history of loss of consciousness or posttraumatic amnesia and a GCS score >12) remain controversial. Recommendations vary from routine admission without computed tomographic (CT) scanning to mandatory CT scanning and admission to CT scanning without admission for selected patients. Previous reports examining this issue have included patients with associated non-CNS injuries who confound the interpretation of the data and affect outcome. We hypothesized that patients with MHI and no other reason for admission with normal neurologic examinations and normal CT scans would have a negligible risk of neurologic deterioration requiring surgical intervention. To validate this hypothesis we studied 2766 patients with an isolated MHI admitted to seven trauma centers between January 1, 1988, and December 31, 1991. There were 1898 male patients and 868 female patients; injury was blunt in 99%. A neurologic examination and a CT scan were performed on 2166 patients; 933 patients had normal neurologic examinations and normal CT scans and none required craniotomy; 1170 patients had normal CT scans and none required craniotomy; 2112 patients had normal neurologic examinations and 59 required craniotomy. The sensitivity of the CT scan was 100%, with positive predictive value of 10%, negative predictive value of 100%, and specificity of 51%. The use of CT alone as a diagnostic modality would have saved 3924 hospital days, including 814ICU days, and $1,509,012 in hospital charges. Based on these data, we believe that CT scanning is essential in the management of patients with MHI and that if the neurologic examination is normal and the scan is negative patients can be safely discharged from the emergency room.

Original languageEnglish (US)
Pages (from-to)385-394
Number of pages10
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume33
Issue number3
DOIs
StatePublished - Jan 1 1992
Externally publishedYes

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Neurologic Examination
Craniocerebral Trauma
Craniotomy
Hospital Charges
Nonpenetrating Wounds
Amnesia
Unconsciousness
Trauma Centers
Patient Admission
Nervous System
Hospital Emergency Service

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries. / Shackford, Steven R.; Wald, Steven L.; Ross, Steven E.; Cogbill, Thomas H.; Hoyt, David B.; Morris, John A.; Mucha, Peter A.; Pachter, H. Leon; Sugerman, Harvey J.; O'Malley, Keith F.; Strutt, Pamela J.; Winchell, Robert J.; Rutherford, Edmund; Rhodes, Michael; Koslow, Max; Demaria, Eric J.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 33, No. 3, 01.01.1992, p. 385-394.

Research output: Contribution to journalArticle

Shackford, SR, Wald, SL, Ross, SE, Cogbill, TH, Hoyt, DB, Morris, JA, Mucha, PA, Pachter, HL, Sugerman, HJ, O'Malley, KF, Strutt, PJ, Winchell, RJ, Rutherford, E, Rhodes, M, Koslow, M & Demaria, EJ 1992, 'The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries', Journal of Trauma - Injury, Infection and Critical Care, vol. 33, no. 3, pp. 385-394. https://doi.org/10.1097/00005373-199209000-00009
Shackford, Steven R. ; Wald, Steven L. ; Ross, Steven E. ; Cogbill, Thomas H. ; Hoyt, David B. ; Morris, John A. ; Mucha, Peter A. ; Pachter, H. Leon ; Sugerman, Harvey J. ; O'Malley, Keith F. ; Strutt, Pamela J. ; Winchell, Robert J. ; Rutherford, Edmund ; Rhodes, Michael ; Koslow, Max ; Demaria, Eric J. / The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries. In: Journal of Trauma - Injury, Infection and Critical Care. 1992 ; Vol. 33, No. 3. pp. 385-394.
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AU - Strutt, Pamela J.

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