CT positive brain injury in mild TBI patients presenting with normal SAC scores.

INTRODUCTION

Traumatic brain injury accounts for over 1 million U.S. emergency department visits annually. A significant percentage of patients undergo CT scans to exclude intracranial bleeds. The Standardized Assessment of Concussion (SAC) is designed to rapidly determine whether a concussion has occurred, (0-30 scale, where ≥25 is considered normal). Although not intended to be used in isolation, results in the normal range are considered an indication of low suspicion of brain injury. This study evaluated the relationship between CT findings of structural injury (CT+) and performance on the SAC.

METHODS

We performed a prospective observational study on mild head-injured patients presenting to the emergency department who underwent CT scans and had SAC evaluations.

RESULTS

We enrolled 368 patients, of which 66 were read by a neuroradiologist as positive (CT+), with an average age of 46.7, and an average Glasgow Coma Scale of 14.85. 38.2% of these CT+ patients had a SAC score ≥25. There were no significant differences between time of injury and CT scan or SAC for those with high or low SAC scores. Both high and low SAC groups contained similar CT+ abnormalities (e.g., hematomas).

CONCLUSIONS

These results indicate that a normal SAC score alone does not exclude intracranial injury.