Two Different Approaches in Obtaining Head Computerized Tomography Scan in Minor Head Injuries

Abstract

Background: The management of minor head injury (GCS score of 15) especially in \t\t\tthe use of computed tomography (CT) scan is still controversial. As \t\t\ta big and developing country, Indonesia faced some problems in the \t\t\tmanagement of minor head injuries. Those problems were limited \t\t\tnumber of CT scan, big number of minor head injured patients \t\t\tassessed in emergency unit and far distance between small cities and \t\t\treferral centers. This study was aimed to provide different \t\t\tapproaches in obtaining CT scan in this group of patients. Methods: This \t\t\twas a cohort prospective study involving 364 head injured patients \t\t\twith a GCS score of 15, aged over six years. All studied clinical \t\t\tdata were recorded and CT scan was obtained. The relationship \t\t\tbetween the clinical risk factors and the presence of abnormal CT \t\t\tscan (the first end point of this study) and the need for surgery \t\t\t(the second end point) were tested by univariate analysis ((X 2 -test). \t\t\tLogistic regression analysis was then used to find the best \t\t\tcombination of these clinical factors that were highly sensitive to \t\t\tdetect abnormal CT scan and the need for surgery. Results: The \t\t\tincidence of abnormal CT scan and the need for surgery were 13.2% \t\t\tand 3.7% respectively. Loss of consciousness (LOC) ( R R \t\t\t4 . 84, \t\t\t95 % CI 1 . 29 \t\t\t- 18 . 13) , \t\t\tamnesia ( R R \t\t\t4 . 45, \t\t\t95% CI 1 . 86 \t\t\t- 10 . 68), \t\t\tcranial soft tissue injury ( R R \t\t\t8 . 56, \t\t\t95% CI 3 . 43 \t\t\t- 21 . 46), \t\t\tskull fracture ( R R \t\t\t6 . 81, \t\t\t95% CI 2 . 04 \t\t\t- 22 . 77), \t\t\tage > 60 years ( R R \t\t\t5 . 56, \t\t\t95% CI 2 . 09 \t\t\t- 14 . 77) were significant clinical factors of abnormal CT \t\t\tscan. While amnesia \t\t\t( R R \t\t\t0 . 068, \t\t\t95% CI 0 . 007 \t\t\t- 0 . 626), cranial soft tissue injury ( RR 0 . 076, \t\t\t95% CI 0 . 009 \t\t\t- 0 . 647) \t\t\tand skull fracture ( R R \t\t\t0 . 145, \t\t\t95% CI 0 . 035 \t\t\t- 0 . 607) \t\t\twere significant clinical factors of the need for surgery . Conclusion: Our \t\t\trecent study provided two different approaches in obtaining head CT \t\t\tscan in minor head injuries, which were dependent on the \t\t\tavailability of CT scan and the aim of taking CT scan. doi: http://dx.doi.org/10.4021/jnr225w