Utility of Repeat Head Computed Tomography in Patients With an Abnormal Neurologic Examination After Minimal Head Injury Full Text
Journal of Trauma, 08/29/2011
Clinical Article
Sifri ZC et al. – Of all patients with minimal head injury (MHI) with an abnormal neurologic examination (NE) at the time of repeat head computed tomography (RHCT), 63% had a persistently abnormal NE (PA–NE). Although a RHCT is beneficial to patients with an acutely deteriorating or unknown NE (U–NE), it appears to be of little value in patients with a PA–NE. Compared with RHCT, serial NE may be a stronger predictor for the need for intervention in patients with MHI
Methods- A retrospective chart review of adult patients presenting to a Level I trauma center from July 2002 to December 2006 with MHI was performed.
- Demographics, injury severity, and HCT findings were collected.
- Patients with an abnormal NE at the time of RHCT were divided into three subgroups: acute deterioration NE (AD–NE), persistently abnormal NE (PA–NE), and unknown NE (U–NE).
- Changes in the management and outcomes after RHCT were compared.
- One hundred seven patients had a MHI with an abnormal NE.
- Of those, seven (6.5%) had a change in management after RHCT.
- At the time of RHCT, 68 patients (63%) had a PA–NE, 21 AD–NE, and 18 U–NE.
- Six patients (29%) with AD–NE, 1 patient (6%) with an U–NE, and no patients with PA–NE required changes in management after RHCT.
- Compared with a RHCT, NE had higher positive and negative predictive values in determining the need for management changes.