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Compelling evidence for discretionary brain computed tomographic imaging in those patients with mild cognitive
C M Dunham1, S Coates, C Cooper
1St. Elizabeth Hospital Trauma Center, Youngstown, Ohio 44501-1790, USA.
Objective:
To identify computed tomographic-detected intracranial hemorrhage (CTIH) risk factors and outcome in mild cognitive impairment (MCI) blunt trauma patients.
Methods:
In 2,587 consecutive patients, 251 (9.7%) had CTIH.
Results:
Analysis is on 2,252 direct transports with 163 CTIH, because transfers were different (7.2 vs. 26.3%, p < 0.0001). CTIH rates for patients age 14-60 and > 60 years were 6.3 and 15.9%, p = 0.001. In those 14-60 years (n = 2,032), CTIH (n = 128) was independently related to arrival Glasgow Coma Scale (GCS) score and cranial soft tissue injury (CSTI) (p = 0.0001). [table: see text] Craniotomy was < or = 0.6% in each group except GCS score of 13 with CSTI, 7.4%. Of those with CTIH, 98.4% survived. Of those at low risk (GCS score of 14 without CSTI and GCS score of 15), 1,504 had no CTIH. Of these, 64.4% were available for serial cognitive evaluation (noncranial injuries mandated hospitalization; tracheal intubation was not required). In those > 60 years (n = 220), CTIH (n = 35) was independently related to GCS and CSTI (p = 0.003). CTIH for GCS score of 15 without CSTI was 5.8%, but > or = 16% for others. One craniotomy was required. Of those with CTIH, 91.4% survived.
Conclusions:
In mild cognitive impairment patients triaged directly to a Level I trauma center, age, arrival GCS score, and cranial soft tissue injury are risk factors for CT-detected intracranial hemorrhage. Neurologic deterioration and death are infrequent. These data strongly suggest that observation and discretionary brain CT imaging are a rational approach for blunt-injury mild cognitive impairment.