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.
Subject(s)
Brain Diseases/diagnosis , Brain Injuries/diagnosis , Craniocerebral Trauma/complications , Tomography, X-Ray Computed , Acute Disease , Adolescent , Adult , Age Distribution , Aged , Brain/diagnostic imaging , Brain Diseases/diagnostic imaging , Brain Diseases/etiology , Brain Injuries/diagnostic imaging , Brain Injuries/etiology , Child , Child, Preschool , Emergency Service, Hospital , Female , Glasgow Coma Scale , Humans , Infant , Male , Middle Aged , Physical Examination , Prognosis , Prospective StudiesABSTRACT
There is a relative lack of information in the literature regarding the epidemiology, functional significance, and clinical resolution of the consequences of minor traumatic brain injury (MTBI). Most retrospective studies to date have been elicited by direct patient interview. Because it was supposed that a minor, but significant, traumatic brain injury would require continuing medical intervention beyond the emergency room contact, a survey was conducted of primary care physicians who were believed to be providing continuing medical care. Had their patients required reevaluations for symptoms of the post-MTBI syndrome? Two hundred fifty-six patients with traumatic brain injury initially seen in the emergency room of two community hospitals were reviewed. One hundred ninety-two (75%) had MTBIs (Glasgow coma scale more than 12 and a negative head CAT scan). One hundred twenty-two physicians were surveyed by mail; 67 (55%) responded. Twenty-one percent of their patients were experiencing symptoms of the post-MTBI syndrome from two to six months after their injuries. Studies relying on patient interviews have also estimated the post-MTBI syndrome at 20%. This correlation implies that "suggestion" does not bias patient interview style research in evaluating the post-MTBI syndrome.
