Prospective Study of Validity of Neurologic Signs in Predicting Positive Cranial Computed Tomography following Minor Head Trauma

2010 ◽  
Vol 25 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Yassir S. Abdul Rahman ◽  
Ahmed Sami S. Al Den ◽  
Kimball I. Maull
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Prospective Study ◽  
Head Trauma ◽  
Clinical Findings ◽  
Cranial Computed Tomography ◽  
Loss Of Consciousness ◽  
Mild Head Injury ◽  
Cranial Ct ◽  
Ct Findings

AbstractIntroduction:The ability to discriminate among a large number of patients with mild head injury to detect those most likely to have an intracranial abnormality may offer an advantage in mass-casualty situations and when clinical needs exceed diagnostic capabilities.Hypothesis:In patients with mild head injury (Glasgow Coma Scale score = 13−15), the likelihood of intracranial abnormality, as defined by cranial computed tomography (CT), varies according to presenting neurologic signs and symptoms.Methods:This prospective study consisted of 152 patients with blunt head trauma and one or more of the following: initial loss of consciousness (LOC), headache, vomiting, convulsions, or amnesia. All underwent cranial CT within one hour of presentation. Positive CT findings were defined as cerebral contusion, extra-axial hematoma, intra-ventricular or subarachnoid hemorrhage, brain edema, and skull fracture. Clinical findings were tabulated and compared with CT findings.Results:The most common symptoms were headache (61%) followed by followed by LOC (45%), vomiting (39%), amnesia (29%), and convulsions (4%). Convulsions were the most predictive of a CT positive finding (80%); history of LOC was least predictive (29%). The presence of two or more clinical findings tended to increase the likelihood of intracranial abnormality, but the association was neither consistent nor additive.Conclusions:Convulsions occurring in a patient with mild head injury are highly predictive of a positive intracranial finding on CT. Headache, amnesia, and vomiting are each likely to show positive findings in approximately 40–45% of cases. Although the least predictive of the neurologic findings studied, loss of consciousness still correlates with a positive cranial CT in 29% of cases. More than one sign or symptom increases the likelihood of concurrent brain injury.

scholarly journals DIAGNOSIS AND MANAGEMENT OF COMPUTED TOMOGRAPHY IN HEAD INJURY

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Dr. Dileep Kumar Jha ◽  
Dr. Rajnikant Narsinhbhai Chauhan
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Head Trauma ◽  
Severe Head Injury ◽  
Mild Head Injury ◽  
Age Group ◽  
Ct Findings ◽  
Craniocerebral Injuries

Introduction: In human body there are many causes of the injuries. Among all the injuries head injury is also one of the most important injuries which may cause morbidity and mortality. Craniocerebral injuries or Traumatic brain injury (TBI) is defined as any structural skull traumatic injury with alterations of cerebral physiology as a result of an external force either in the form of chemical energy, mechanical energy, electrical energy or thermal heating. Globally craniocerebral injuries or Traumatic brain injury (TBI)is cause of disability in young patients, especially those  <40 years of age. TBI is classified as mild, with most showing adequate and quick recovery. Nevertheless there are some kinds of TBI which showed persistent disabling symptoms that interrupt with their normal daily routine activities. Brain imaging is very important for the patients who suffer traumatic brain injury. In the emergency services Computed tomography (CT) is recommended as first assessment that provides initial information and diagnosis to identify the need of surgery. It also helps in the following of the patient and the evolution of pathology. Many studies suggest that CT can be used to predict patient outcomes. Computed tomography (CT) is an imaging technique which uses as dynamics of injected contrast material, allows rapid quantitative and qualitative evaluation of cerebral perfusion by generating cerebral blood volume (CBV), cerebral blood flow (CBF) and mean transit time (MTT) maps providing clinically important information with stroke subarachnoid hemorrhage (SAH)and head injury. Aim: The main aim of this study is to evaluate the computed tomography findings sustaining head injury and role of computed tomography scan in head injury. Material and Methods: During the study total 90 patients with head injury were included with different age group from 20 to 70 years old. Glasgow coma score (GCS) range 4–15 (mild head injury: GCS >14; moderate head injury: GCS = 9–13; severe head injury GCS <8) were also included in this study. For all the patients with head injury Computed tomography (CT) image were performed with siemen's somatom spirit dual slice spiral CT machine and a protocol of contiguous axial 5-mm sections through the posterior fossa and a contiguous 10 mm axial sequential scans for the rest of the brain and thinner cuts were also taken whenever required. For visualize any fractures of the skull bone algorithms with wide window settings were studied. After initial resuscitation, severity of the cranio-cerebral trauma was graded with the help of Glasgow Coma Scale (GCS) into mild head injury (GCS13- 15), moderate head injury (GCS 9-12) and severe head injury (GCS 3-8). Result: Among total patients sixty five (72.2%) patients were male and twenty five (27.8 %) were female with age range from 20 to 70 years old. In the age group 31-50 year group showed highest frequency of head trauma. The most common causes of head injury were RTA (65.6%) followed by fall injuries (20%) and physical assaults (14.4%). Among patients with head injuries Loss of consciousness and vomiting were the commonest clinical features brought to emergency. Out of 90 cases 59 (65.5%) cases showed mild head injury followed by 14(15.6%) cases sustained moderate head injury and 17(18.9%) had severe head injury. In all types of severity of head injury RTA was the prime etiological factor. Out of total cases 31(34.4%) had normal CT findings and 59(65.6%) had abnormal CT findings. Abnormal CT findings were seen in 59(65.6%) sustaining mild head injury and in all the patients with moderate and severe head injury. Out of 90 cases 13 cases with severe head injury had mortality. The most common mode of injury to cause the mortality was RTA. Five patients with severe head injury also had cervical spine injury Conclusion: This study concludes that use of CT in head trauma can finds high prevalence of head trauma related to CT. Therefore CT should be done when clinically necessary that helps to reduce cost and avoids unnecessary exposure to radiation. Keywords: Head injury, Traumatic brain injury (TBI), computed tomography (CT), Glasgow coma scale (GCS)

Cranial Computed Tomography Scans in Children After Minimal Head Injury With Loss of Consciousness

1994 ◽  
Vol 24 (4) ◽  
pp. 640-645 ◽  
Author(s):  
Robert L Davis ◽  
Neil Mullen ◽  
Martin Makela ◽  
James A Taylor ◽  
Wendy Cohen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Cranial Computed Tomography ◽  
Loss Of Consciousness ◽  
Computed Tomography Scans

Patients with Blunt Head Trauma on Anticoagulation and Antiplatelet Medications: Can They be Safely Discharged after a Normal Initial Cranial Computed Tomography Scan?

2014 ◽  
Vol 80 (6) ◽  
pp. 610-613 ◽  
Author(s):  
Salvatore Docimo ◽  
Aleksandr Demin ◽  
Fausto Vinces
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Head Trauma ◽  
International Normalized Ratio ◽  
Cranial Computed Tomography ◽  
Mechanism Of Injury ◽  
Computed Tomography Scan ◽  
Cranial Ct ◽  
Blunt Head Trauma ◽  
Tomography Scan

The literature reports delayed intracranial hemorrhage (ICH) after blunt trauma in patients taking preinjury anticoagulant and antiplatelet (AC/AP) medications. We sought to evaluate the incidence of delayed ICH at our institution and hypothesize that patients taking AC/AP medications who are found to have a negative first computed tomography (CT) scan will not require a second CT scan. A total of 303 patients were retrospectively reviewed. Age, gender, mechanism of injury, international normalized ratio (INR), initial and secondary cranial CT findings, and outcomes were recorded. One hundred sixty-eight (55.4%) were found to be taking AP/AC medications. Ninety-six (57%) were male and 72 (43%) female. Aspirin use was 42.8 per cent (72 of 168), clopidogrel next (39 of 168 [23.0%]), and warfarin least (18 of 168 [10.7%]). One hundred sixty-six (98.8%) presented with significant findings on the first CT scan. Fourteen (87.5%) of the 16 patients with an INR 2.0 or higher presented with an ICH on the first CT. Ninety percent of patients with an INR 1.5 or higher presented with positive findings on the first CT scan. One hundred per cent of patients with an INR 3.0 or higher presented with an ICH on the first CT scan. The incidence of a delayed ICH was two of 168 (1.19%). Of those two patients with a delayed ICH, 100 per cent were taking warfarin and had an INR greater than 2.0. The incidence of delayed ICH was 1.19 per cent. The protocol requiring a second CT scan for all patients on AC/AP medications after a negative first CT scan should be questioned. For patients with blunt head trauma taking warfarin or a warfarin–aspirin combination, a repeat cranial CT scan after a negative initial CT is acceptable. For patients taking clopidogrel, a period of observation may be warranted.

152 The Value of Scheduled Repeat Cranial Computed Tomography Following Mild Head Injury

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. E561 ◽  
Author(s):  
Saleh A. Almenawer ◽  
Julia Bogza ◽  
Blake Yarascavitch ◽  
Niv Sne ◽  
Forough Farrokhyar ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Cranial Computed Tomography ◽  
Mild Head Injury

scholarly journals Predicting factors for abnormal brain computed tomography in children with minor head trauma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Taraneh Naghibi ◽  
Mina Rostami ◽  
Behrad Jamali ◽  
Zhaleh Karimimoghaddam ◽  
Alireza Zeraatchi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Head Trauma ◽  
Clinical Findings ◽  
Cranial Computed Tomography ◽  
Minor Head Trauma ◽  
Brain Ct ◽  
Predicting Factors ◽  
Level Of Consciousness ◽  
The Impact ◽  
Abnormal Brain

Abstract Background Deciding whether a cranial Computed Tomography (CT) scan in a patient with minor head trauma (MHT) is necessary or not has always been challenging. Diagnosing Traumatic Brain Injury (TBI) is a fundamental part of MHT managing especially in children who are more vulnerable in terms of brain CT radiation consequences and TBI. Defining some indications to timely and efficiently predict the likelihood of TBI is necessary. Thus, we aimed to determine the impact of clinical findings to predict the need for brain CT in children with MHT. Methods In a prospective cohort study, 200 children (2 to 14 years) with MHT were included from 2019 to 2020. The data of MHT-related clinical findings were gathered. The primary and secondary outcomes were defined as a positive brain CT and any TBI requiring neurosurgery intervention, respectively. In statistical analysis, we performed Binary Logistic regression analysis, Fisher’s exact test and independent samples t-test using SPSS V.26. Results The mean age of participants was 6.5 ± 3.06 years. Ninety patients underwent brain CT. The most common clinical finding and injury mechanism were headache and falling from height, respectively. The results of brain CTs were positive in seven patients (3.5%). We identified three predicting factors for an abnormal brain CT including headache, decreased level of consciousness, and vomiting. Conclusion We showed that repetitive vomiting (≥2), headache, and decreased level of consciousness are predicting factors for an abnormal brain CT in children with MHT.

The Value of Scheduled Repeat Cranial Computed Tomography After Mild Head Injury

Neurosurgery ◽  
2013 ◽  
Vol 72 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Saleh A. Almenawer ◽  
Iulia Bogza ◽  
Blake Yarascavitch ◽  
Niv Sne ◽  
Forough Farrokhyar ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Cranial Computed Tomography ◽  
Mild Head Injury

Pediatric Minor Head Trauma: Factors Affecting the Anxiety of Parents

2021 ◽  
pp. 000992282110096
Author(s):  
Hasan Aldinc ◽  
Cem Gun ◽  
Serpil Yaylaci ◽  
Erol Barbur
Keyword(s):  
Computed Tomography ◽  
Head Trauma ◽  
Pediatric Patients ◽  
Positive Impact ◽  
Cranial Computed Tomography ◽  
Sufficient Information ◽  
Minor Head Trauma ◽  
Computed Tomography Imaging ◽  
Factors Affecting ◽  
X Ray

Managing the anxiety of the parents of pediatric patients with head trauma is challenging. This study aimed to examine the factors that affect anxiety levels of parents whose children were admitted to the emergency department with minor head trauma. In this prospective study, the parents of 663 consecutive pediatric patients were invited to answer a questionnaire. Parents of 600 children participated in the study. The parents who believed they were provided sufficient information and who were satisfied with the service received had significantly more improvement in anxiety-related questions. Cranial X-ray assessment had a significantly positive impact on the anxiety of the parents, whereas cranial computed tomography and neurosurgery consultation did not. In assessing pediatric minor head trauma, cranial computed tomography imaging and neurosurgery consultation should not be expected to relieve the anxiety of the parents. However, adequately informing them and providing satisfaction are the factors that could lead to improvement.

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