Citation

Foks KA, Dijkland SA, Lingsma H, Polinder S, van den Brand CL, Jellema K, Jacobs B, van der Naalt J, Sir Ö, Jie KE, Schoonman GG, Hunink MGM, Steyerberg EW, Dippel DWJ. J. Neurotrauma 2019; ePub(ePub): ePub.

Affiliation

Erasmus MC University Medical Center Rotterdam, Department of Neurology, Rotterdam, Zuid-Holland, Netherlands ; d.dippel@erasmusmc.nl.

Copyright

(Copyright © 2019, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2018.6354

PMID

30860435

Abstract

Various guidelines for minor head injury focus on patients with a Glasgow Coma Scale (GCS) score of 13-15 and loss of consciousness (LOC) or posttraumatic amnesia (PTA), while clinical management for patients without LOC or PTA is often unclear. We aimed to investigate the effect of presence and absence of LOC or PTA on intracranial complications in minor head injury. A prospective multicenter cohort study of all patients with blunt head injury and GCS score of 15 was conducted at six Dutch centers between 2015 and 2017. Five centers used the national guideline and one center used a local guideline, both based on the CHIP prediction model, to identify patients in need of a computed tomography (CT) scan. We studied the presence of traumatic findings and neurosurgical interventions in patients with and without LOC or PTA. In addition, we assessed the association of LOC and PTA with traumatic findings with logistic regression analysis and the additional predictive value of LOC and PTA compared to other risk factors in the CHIP model. Of 3914 patients, 2249 (58%) experienced neither LOC nor PTA and in 305 (8%) LOC and PTA was unknown. Traumatic findings were present in 153/1360 (11%) patients with LOC or PTA and in 67/2249 (3%) patients without LOC and PTA. Five patients without LOC and PTA had potential neurosurgical lesions and one patient underwent a neurosurgical intervention. LOC and PTA were strongly associated with traumatic findings on CT, with adjusted odds ratios of 2.9 (95%CI 2.2-3.8) and 3.5 (95%CI 2.7-4.6), respectively. To conclude, patients with minor head injury with neither LOC nor PTA are at risk of intracranial complications. Clinical guidelines should include clinical management for patients without LOC and PTA, and they should include LOC and PTA as separate risk factors rather than as diagnostic selection criteria.

Language: en

Keywords

ADULT BRAIN INJURY; CT SCANNING; GUIDELINES; TRAUMATIC BRAIN INJURY