Original contribution
A prospective study to identify high-yield criteria associated with acute intracranial computed tomography findings in head-injured patients

https://doi.org/10.1016/0735-6757(93)90160-DGet rights and content

Abstract

We conducted a multicenter, prospective study of head-injured patients to identify high-yield clinical criteria for acute intracranial injuries. Emergency patients with a history of blunt head trauma occurring within 2 weeks and who underwent nonenhanced cranial computed tomography (CT) were entered onto the study during a 12-month period. Of the 264 patients, 32 (12%) had abnormal CT findings. Nine high-yield variables were associated with abnormal CT findings: alcohol use before injury, antegrade amnesia, prolonged loss of consciousness, anisocoria and/or fixed and dilated pupils, abnormal Babinski reflex, focal motor paralysis, cranial nerve deficit, Glasgow coma scale score of less than 15, and clinical signs of basilar skull fracture. Patients 2 years old or younger or older than 60 years of age showed a significantly greater prevalence of abnormal CT findings than patients of other ages.

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    Citation Excerpt :

    Furthermore, many of the injuries detected do not require medical or surgical intervention. Recent attempts to develop selective imaging recommendations for patients with blunt head trauma have uniformly found that all patients with significant intracranial lesions exhibit historical or physical evidence suggesting the presence of ICI.2,4-6,21 However, these combined studies contain a total of only 60 patients having surgically important lesions.

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Presented at the Society for Academic Emergency Medicine, Minneapolis, MN, May 1990.

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