Identifying predictors of an abnormal computed tomographic scan among patients with a head injury and a Glasgow Coma...

The aim of this study was to determine the proportions of patients with a head injury and a Glasgow Coma Scale of 15 with an abnormal computed tomographic (CT) head scan and to explore its predictors.

We conducted a retrospective study on adult patients with such injuries. Patients were risk stratified to undergo a head CT and subsequently discharged or admitted to a neurosurgical (NS) intensive care unit (ICU)/high-dependency (HD) NS or general ward (GW) and observation ward [Emergency Diagnostic and Therapeutic Centre (EDTC)]. The primary outcomes were proportions of abnormal CT results and NS interventions. The secondary outcomes included rates of disposition status, and the distribution and predictors of abnormal CT results. Data were analysed using descriptive statistics. We identified predictors of an abnormal head CT using logistic regression and reported their odds ratios (ORs) and 95% confidence intervals.

We reviewed 2038 complete records. A total of 1088 scans were performed; 115 (10.6%) were abnormal. There were 962 (47.2%) discharges and 1076 (52.8%) admissions; six (0.6%) required NS interventions and ICU/HD admission. The proportions of GW admissions (n=1070) were as follows: EDTC 78.0%; NS 18.0%; and medical 4.0%. The proportions of abnormal CT results among these disposition statuses were as follows: NS ICU/HD 6/6 (100%); EDTC 59/835 (7.1%); NS GW 47/188 (25.0%); and medical GW 3/33 (9.1%). We identified three predictors, namely, vomiting [OR 2.23 (1.39-3.58)]; loss of consciousness [OR 1.56 (1.03-2.36)]; and amnesia [OR 2.08 (1.30-3.31)].

Abnormal CT and NS interventions were infrequent in patients with a head injury and a Glasgow Coma Scale of 15. We identified three predictors of abnormal head CTs.