Analysis of the reliability of clinical examination in predicting traumatic cerebral lesions and skull fractures in patients with mild and moderate head trauma

• Authors: Andrzej Żyluk , Agnieszka Mazur , Bernard Piotuch , Krzysztof Safranow
• Languages of publication: EN

Abstracts

EN

The aim of the study was to assess the reliability of neurological examination and other factors in predicting traumatic cerebral lesions and skull fractures in patients with mild and moderate head trauma (GCS 10-15). Material and methods. Over a one-year period, 227 patients: 145 male and 82 female, aged a mean of 51 years who sustained mild or moderate head trauma (GSC 10-15) were examined neurologically and had performed head CT scans. The neurological examination as a whole and each finding of the neurological examination were tested as predictors of the presence of traumatic abnormalities in the head CT scan. Results. Post-traumatic lesions in head CT scan were found in 109 patients (48%): skull fractures in 66 of these and brain injuries in 94; fifty-eight patients had skull fracture combined with brain injury. Seventeen patients required neurosurgical intervention (hematoma evacuation). Abnormal neurological examination showed the highest reliability in identifying patients with brain injuries in CT (sensitivity 87%, specificity 79%). Of single findings, gait abnormalities and consciousness disturbances, present in sober patients, were the strongest predictors of cerebral lesions. Likewise, abnormal neurological examination was the best indicator of skull fractures (sensitivity 77%, specificity 63%). Gait abnormalities and “racoon eyes” present in alcohol intoxicated patients were the strongest individual predictors of skull fractures. Conclusion. Results of our study show neurological abnormalities as the most reliable (although not 100% accurate) in identifying patients who are likely to have brain injuries and/or skull fracture following head trauma. Use of clinical decision rules may reduce the number of head CT scans performed “just in a case”.

Keywords

EN

head injury   head computer tomography   clinical decision rules  

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2013
• Volume: 85
• Issue: 12
• Pages: 699-705

Dates

published

1 - 12 - 2013

online

25 - 01 - 2014

References

• 1. Falmirski ME , Gonzales R, Roidriguez A, Wilberger J: The need for head computed tomography in patients sustaining loss of conciousness after mild head injury. J Trauma 2003; 55: 1-6.
• 2. Rohacek M, Albrecht M, Kleim B et al.: Reasons for ordering computed tomography scans of the head in patients with minor brain injur y . I n j u r y 2 0 1 2 , d o i : 1 0 . 1 0 1 6 / j . i n j u r y .2012.01.001
• 3. Stippler M, Smith C, McLean AR et al.: Utility of routine follow-up head CT scanning after mild traumatic brain injury: a systematic review of the literature. Emerg Med 2012, doi: 10.1136/emermed-2011-200162.[Crossref][WoS]
• 4. Miller EC , Derlet RW , Kisner D: Minor head trauma: is computed tomography always necessary? Ann Emerg Med 1996; 27: 290-94.
• 5. Nagy KK, Joseph KT, Krosner SM et al.: The utility of head computed tomography after minimal head injury. J Trauma 1999; 46: 268-70.
• 6. Mower WR , Hoffman JR, Herbert M et al.: Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma 2005; 59: 954-59.
• 7. Goldberg J, McClaine RJ, Cook B et al.: Use of a mild traumatic brain injury gideline to reduce inpatient hospital imaging and charges. J Pediatr Surg 2011; 46: 1777-83.[WoS]
• 8. Stiell IG, Wells GA, Vandemheen K et al.: The Canadian CT Head Rule for patients with minor head injury. Lancet 2001; 357: 1391-96.
• 9. Stiell IG, Clement CM , Rowe BH et al.: Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury.JAMA 2005; 294: 1511-18.

Identifiers

DOI

10.2478/pjs-2013-0107