CT scan in minor head injury: a guide for rural doctors

Minor head injury in a developing country like Malaysia is managed by primary care physicians and/or medical assistants in district hospitals. These patients are seen initially in their local hospitals, which have at least an X-ray machine for the purpose of screening. This study aimed to guide thes...

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Bibliographic Details
Published in:	Journal of clinical neuroscience Vol. 11; no. 8; pp. 835 - 839
Main Authors:	Abdul Latip, L.S., Ahmad Alias, N.A., Ariff, A.R., Shuaib, I.L., Abdullah, J., Naing, N.N.
Format:	Journal Article
Language:	English
Published:	Scotland Elsevier Ltd 01-11-2004
Subjects:	Adolescent Adult Aged Child clinical guidelines Craniocerebral Trauma - diagnosis Craniocerebral Trauma - epidemiology Craniocerebral Trauma - etiology Cross-Sectional Studies developing country Female Guidelines as Topic - standards Humans Malaysia Malaysia - epidemiology Male Middle Aged minor head injury Retrospective Studies Tomography, X-Ray Computed - instrumentation Tomography, X-Ray Computed - methods Malaysia Malaysia developing country clinical guidelines minor head injury
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Summary:	Minor head injury in a developing country like Malaysia is managed by primary care physicians and/or medical assistants in district hospitals. These patients are seen initially in their local hospitals, which have at least an X-ray machine for the purpose of screening. This study aimed to guide these physicians to manage these patients at a primary care level. A cross-sectional study was conducted and the study revealed significant predictors of significant computed tomographic (CT) findings. The presence of a Glasgow coma scale (GCS) score of 14 or 13 was associated with the risk of developing significant CT findings compared to patients with a GCS of 15 ( p < 0.001). Thirty-seven out of 50 patients with GCS of 14 or 13 developed clinically significant brain injury on CT scan. Similarly, the presence of skull fracture was associated with the risk of developing CT abnormalities ( p < 0.001). Forty-two out of 51 patients with skull fracture developed clinically significant CT findings. Vomiting was associated with developing CT abnormalities ( p = 0.017). Twenty-seven out of 40 patients with vomiting showed significant CT findings. Soft tissue injury was also found to be associated with developing CT abnormalities ( p = 0.007). Therefore, we propose reclassifying minor head injury based on the GCS score. Patients with a GCS score of 15 were classified as having mild head injury, while patients with a GCS score of 13 or 14 were at higher risk of developing brain injury and therefore categorized as high risk mild head injury. This group requires emergency CT scan examination, especially when associated with non-motor vehicle accidents, abnormal central nervous system (CNS) examination, craniofacial injuries or skull fractures. They should be referred to a general surgical unit which can treat head injuries or a neurosurgical tertiary centre.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0967-5868 1532-2653
DOI:	10.1016/j.jocn.2003.12.017