Impact of clinical symptoms on CT ordering policy in minor head injuries

The aim of our study was to determine the impact of clinical signs and symptoms on CT ordering policy in minor head injuries.

The study encompassed 1830 patients that have sustained minor or mild head injury, as assessed by clinical criteria. Basic clinical variables were recorded and a subset of patients meeting either Canadian or New Orleans criteria were subjected to CT. Outcome in terms of "positive" CT scans and number of patients requiring surgery was recorded.

The mean age was 30.4 years (ranging from 10 days to 80 years). 176 patients were subjected to CT scan (based on clinical criteria). CT scan revealed intracranial pathology in 29 patients (16.5% of patients subjected to CT scan) and 19 patients were subsequently subjected to surgery (accounting for 10.8% of patients subjected to CT scan and 1.0% of all patients with mild or minor head injuries). Brain contusions were detected in 10 (5.7%) patients, followed by epidural hematomas (10 patients or 5.7% were found to harbor an epidural hematoma) and subdural hematomas, that were found in 7 patients or 4.0% of patients subjected to CT scan.

Despite numerous studies that have analyzed the importance of clinical signs and CT in the diagnosis and treatment of minor head injuries, there is still much controversy about the mode of treatment of these patients. Canadian protocol really reduces the need for CT of the brain in relation to the New Orleans protocol, which suggests more observation in hospital patients with minor or mild head injury.

The authors conclude that minor or mild head injuries should prompt a CT as recommended by Canadian or New Orleans guidelines and that the strongest scientific evidence available at this time would suggest that a CT strategy is a safe way to triage patients for admission.