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Previous Volume 343:100-105 July 13, 2000 Number 2 Next

	Full Text PDF Editorial by Marx, J. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Computed tomography (CT) is widely used as a screening test in patients with minor head injury, although the results are often normal. We performed a study to develop and validate a set of clinical criteria that could be used to identify patients with minor head injury who do not need to undergo CT.

Methods In the first phase of the study, we recorded clinical findings in 520 consecutive patients with minor head injury who had a normal score on the Glasgow Coma Scale and normal findings on a brief neurologic examination; the patients then underwent CT. Using recursive partitioning, we derived a set of criteria to identify all patients who had abnormalities on CT scanning. In the second phase, the sensitivity and specificity of the criteria for predicting a positive scan were evaluated in a group of 909 patients.

Results Of the 520 patients in the first phase, 36 (6.9 percent) had positive scans. All patients with positive CT scans had one or more of seven findings: headache, vomiting, an age over 60 years, drug or alcohol intoxication, deficits in short-term memory, physical evidence of trauma above the clavicles, and seizure. Among the 909 patients in the second phase, 57 (6.3 percent) had positive scans. In this group of patients, the sensitivity of the seven findings combined was 100 percent (95 percent confidence interval, 95 to 100 percent). All patients with positive CT scans had at least one of the findings.

Conclusions For the evaluation of patients with minor head injury, the use of CT can be safely limited to those who have certain clinical findings.

Source Information

From the Sections of Emergency Medicine (M.J.H., C.A.P., T.J.M., S.L., P.M.C.D.) and Emergency Radiology (E.B.), Louisiana State University Health Science Center at New Orleans, New Orleans.

Address reprint requests to Dr. Haydel at the Emergency Medicine Offices, Charity Hospital, 13th Fl., 1532 Tulane Ave., New Orleans, LA 70112, or at micellehaydel{at}yahoo.com.

Full Text of this Article

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Extract | Full Text  
N Engl J Med 2000; 343:1570-1571, Nov 23, 2000. Correspondence

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