Predictors of positive head CT scan and neurosurgical procedures after minor head trauma.

BACKGROUND

There continues to be an ongoing debate regarding the utility of head CT scans in patients with a normal Glasgow Coma Scale (GCS) after minor head injury. The objective of this study is to determine patient and injury characteristics that predict a positive head CT scan or need for a neurosurgical procedure (NSP) among patients with blunt head injury and a normal GCS.

MATERIALS AND METHODS

Retrospective analysis of adult patients in the National Trauma Data Bank who presented to the ED with a history of blunt head injury and a normal GCS of 15. The primary outcomes were a positive head CT scan or a NSP. Multivariate logistic regression controlling for patient and injury characteristics was used to determine predictors of each outcome.

RESULTS

Out of a total of 83,566 patients, 24,414 (29.2%) had a positive head CT scan and 3476 (4.2%) underwent a NSP. Older patients and patients with a history of fall (compared with a motor vehicle crash) were more likely to have a positive finding on a head CT scan. Male patients, African-Americans (compared with Caucasians), and those who presented with a fall were more likely to have a NSP.

CONCLUSIONS

Older age, male gender, ethnicity, and mechanism of injury are significant predictors of a positive finding on head CT scans and the need for neurosurgical procedures. This study highlights patient and injury-specific characteristics that may help in identifying patients with supposedly minor head injury who will benefit from a head CT scan.