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Which Patients with Minor Head Injury Don't Need a CT Scan?

In most emergency departments (EDs), CT scans are done routinely for patients with minor head injuries, but most of these scans are negative. In this study from New Orleans, researchers developed conservative criteria for CT scanning of patients with minor head injury (defined as transient loss of consciousness after the injury, but normal neurologic exam and normal Glasgow coma score on arrival at the ED). Patients younger than 3 years were excluded.

The first phase included 520 patients. All 36 patients with positive CT scans had at least 1 of the following 7 findings: headache, vomiting, age older than 60, drug or alcohol intoxication, short-term memory deficit, seizure, or physical evidence of trauma above the clavicles. Of the 484 patients with negative CT scans, 116 had none of the 7 findings.

In a second phase, the 7 defined criteria were applied to 909 additional patients with minor head injury; all 57 patients with positive CT scans had at least 1 of the cruteria (sensitivity, 100 percent). Of the 852 patients with negative CT scans, 212 had none of the 7 criteria (specificity, 25 percent).

Comment: In this study, 7 relatively simple clinical criteria identified all patients with minor head injury who had abnormal CT scans. Although these criteria had a low specificity, their use would have eliminated safely about 1 in 5 CT scans in this population. The findings of this study should be validated at other centers.

— AS Brett

Published in Journal Watch General Medicine July 21, 2000

Citation(s):

Haydel MJ et al. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000 Jul 13 343 100-105.

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