Intracranial injury following minor head trauma

One hundred twelve patients presenting with a Glascow Coma Scale (GCS) score greater than or equal to 13 with a history of minor head trauma were prospectively studied to determine if certain historic or physical examination variables would predict which of these patients were at increased risk for intracranial injury. Patients either underwent cranial computed axial tomography (CT) or were followed up by phone at 4 weeks to determine major morbidity or mortality. Thirty-five patients underwent CT scanning of the head and eight demonstrated intracranial injury. Five patients were treated nonoperatively, and three patients had neurosurgical intervention. One patient died following surgery. At the 4-week follow-up no patient was found to have suffered any major morbidity or mortality. Stepwise logistic regression found age over 40 years (P = .05, odds ratio = 6.4, 95% confidence interval 1.0 to 38.8) and complaint of headache (P = .039, odds ratio 8.167, 95% confidence interval 1.074 to 62.09) to be significantly predictive of intracranial injury. All eight patients with positive CTs had a GCS score of 15. The authors conclude that intracranial injury does exist in patients suffering minor head trauma with a GCS score of 13 or above. Age over 40 years and complaint of headache are associated with an increased risk of intracranial injury.