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Predicting Serious Consequences of Minor Head Injury

Dutch researchers develop a rule for predicting who needs CT.

Most patients with minor head injury do not have traumatic abnormalities on computed tomography. To develop a rule to predict detection of intracranial traumatic CT abnormalities or need for neurosurgical intervention, Dutch researchers studied 3181 patients aged 16 or older with recent (within the past 24 hours) blunt head trauma, a Glasgow Coma Scale (GCS) score of 13 or 14, or a score of 15 with a risk factor for more severe outcome (e.g., loss of consciousness, neurologic deficit, amnesia, vomiting, coagulopathy, intoxication). Fewer than half of the patients presenting with head injury to four hospitals during the study period met these criteria.

The researchers used statistical methods to derive a simple model for clinical use. This model classified risk factors for intracranial traumatic lesions as major (vomiting; amnesia for 4 or more hours after the trauma; signs of skull fracture; GCS <15; and several others) or minor (fall; short-term memory deficit; skull contusion; loss of consciousness; and several others). The presence of one major or two minor risk factors identified all 17 cases that required neurosurgical intervention and 96% of the 243 patients with intracranial traumatic lesions (with specificity of 23%–25%).

Comment: This rule, despite its weak specificity, could reduce CT scan use. But it needs validation in other populations before it can be recommended for widespread clinical use.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine April 10, 2007

Citation(s):

Smits M et al. Predicting intracranial traumatic findings on computed tomography in patients with minor head injury: The CHIP prediction rule. Ann Intern Med 2007 Mar 20; 146:397-405.

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