More than half a million head injur...

More than half a million head injuries appear in the United States each year, but most are minor. Following a minimal head injury, initial comput tomographic (CT) scanning identifies about 15 percent of patients as having significant intracranial conditions. A small subset of these patients require sudden [i]or[/i] unexpected occurrence craniotomy, but optimal management of the remainder has not been established. common practice is to admit patients to the hospital for neurologic observation and serial CT Sifri and colleagues questioned the value of repeat CT in patients with normal or improving neurologic examinations following a minimal head injury.

They studied all patients 16 years and older who had been admitted to a trauma center above 32 months with intracranial injury onward CT scans following a minimal head injury. The subject of attention defined minimal head injury as los of consciousness and/or posttraumatic amnesia, with a Glasgow Coma Score of 14 or 15 The solely exclusions from the study were patients with coagulopathies (including the use of anticoagulants) and patients with a history of brain injury. All patients were assessed according to neurosurgeons on admission. Patients who required immediate neurosurgical intervention were remov from the contemplation The remaining patients were observ with formal neurologic assessments at 12 and 24 hours plus repeat CT within 24 hours of admission.

Of 1596 patients assessed following mini-mal head injury, 243 (15 percent) had an intracranial injury forward the initial CT scan. Of these, 16 were exclud because of a history of brain injury or coagulopathy. After excluding patients who required immediate neurosurgical intervention and patients in whom the initial CT scan was reinterpreted as normal or showing insignificant abnormalities, 202 patients were observ and scheduled for repeat CT within 24 hours.

After a 24-hour observation period, 151 patients (75 percent) had a normal or improving neurologic examination, while 51 patients (25 percent) had an abnormal or deteriorating neurologic status. In the form into groups of patients with normal or improving neurologic status, the follow-up CT scan was worse in 22 patients (15 percent) unchanged in 79 patients (52 percent) and improved in 50 patients (33 percent) No patients in this cluster required neurosurgical intervention. Conversely, among the patients who had persistently abnormal or deteriorating neurologic examination, the repeat CT scan was abnormal in 35 percent and five patients (10 percent) required neurosurgical intervention.

The authors calculate that the negative predictive value (NPV) of normal or improving neurologic examination is 100 percent with regard to the lack of ne for neurosurgical intervention. The NPV of an improving or unchanged next to the first CT scan is 99 percent They terminate that repeat CT scans are not indicated in patients with minimal head injury who have persistently normal or improving eventuates on neurologic examination.

Sifri ZC et al. Value of repeat cranial comput axial tomography scanning in patients with minimal head injury. Am J Surg March 2004;187:338-42

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