Rate of Intracranial Hemorrhage After Minor Head Injury.

Phillip A Bonney,Amy Briggs,Robert G Briggs,Frank Attenello,Casey A Jarvis,Steven L Giannotta

doi:10.7759/cureus.10653

Abstract

Introduction: Computed tomography scans of the head (CTH) are an important component of the initial patient evaluation after blunt head trauma in select patients. Here we review findings of CTH performed for mild traumatic brain injury (TBI) at a Level I trauma center over a two-year period. We subsequently discuss the role and limitations of published clinical decision rules aiming to decrease unnecessary CTH in mild TBI patients.Methods: We reviewed all Emergency Department CTH obtained after blunt head trauma between 2010 and 2011. Patient demographics and radiology report texts were collected. Reports were cross-referenced with our institutional trauma database to obtain initial Glasgow Coma Scale (GCS). Mild TBI was defined by an initial GCS 13-15 with or without loss of consciousness or post-traumatic amnesia.Results: There were 5,634 mild TBI patients evaluated with CTH. A total of 477 scans (8.5%) were positive for intracranial hemorrhage. Of these, 188 (39.4%) showed more than one type of intracranial hemorrhage. The most common findings were subdural hematomas (262, 4.7% of scans), traumatic subarachnoid hemorrhages (252, 4.5% of scans), and cerebral contusions/intraparenchymal hematomas (212, 3.8% of scans). Older age (p<0.001) and male gender (p<0.001) were associated with positive CTH.Conclusions: The rate of positive CTH in mild TBI patients in our population falls within a historical range. The clinical and medicolegal implications of missed intracranial hemorrhage have remained important factors limiting the implementation of clinical decision rules in screening mild TBI patients for CTH.

Highlights

Computed tomography scans of the head (CTH) are an important component of the initial patient evaluation after blunt head trauma in select patients
Traumatic intracranial findings are present in 5-10% of mild traumatic brain injury (TBI) patients who receive CTH, and neurosurgical intervention is necessary in 0.5-1% [1,2,3,4]
Reports were reviewed for presence of any of the following: subdural hematoma, subarachnoid hemorrhage, intraparenchymal/intracerebral hematoma, hemorrhagic contusion, or intraventricular hematoma

Summary

Introduction

Computed tomography scans of the head (CTH) are an important component of the initial patient evaluation after blunt head trauma in select patients. We review findings of CTH performed for mild traumatic brain injury (TBI) at a Level I trauma center over a two-year period. The initial evaluation of patients sustaining traumatic head injuries commonly includes a head computed tomography scan (CTH). Multiple prospective observational studies have been used to establish sets of clinical decision rules to identify patients who do not warrant testing with CTH. The premise of such tools is to reduce the unnecessary use of CTH in patients unlikely to harbor traumatic findings, while identifying patients at risk for intracranial hemorrhage. Data suggest that CTH use in emergency departments is increasing [7,8]

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Discussion

Conclusion