The need for head computed tomography in patients sustaining loss of consciousness after mild head injury

Many management schemes have incorporated mandatory head computed tomography (HCT) to evaluate a patient sustaining blunt head trauma with a history of loss of consciousness (LOC). Commonly, this is despite physical examination findings warranting such a workup. This study is intended to better identify the significance of selective criteria, a set of constitutional signs and symptoms (CSS) for head injury, to screen patients sustaining blunt head trauma and LOC.

Over a 141/2-month period, data were prospectively collected on adults with a history of LOC and a Glasgow Coma Scale score of 14 to 15. Patients were screened for the presence of 10 typical CSS for head injury at admission before undergoing computed tomography of the head. Data collected also included mechanism of injury and alcohol intoxication.

Three hundred thirty-one patients met criteria, of which 195 showed no CSS for head injury. Eleven (5.6%) of these patients were found to have HCT evidence of intracranial injury but resulted in no acute medical intervention. One hundred thirty-six patients had CSS, of which 29 (21.3%) had HCT evidence of injury and resulted in a lengthier hospital stay.

The liberal use of HCT in patients without CSS for head injury did not influence patient care, with no increase in morbidity or mortality. These results suggest that LOC alone is not predictive of significant head injury and is not an absolute indications for HCT. More objective criteria, such as CSS, should be used before initiating a costly workup where further diagnostic and therapeutic intervention is unlikely after mild head injury.