Utility of CT in Head Injury- A Prospective Study

Bansal, Anil Kumar; Gupta, Anil Kumar · 2020 · Crossref

DOI: 10.47009/ajmrr.2020.8.1.13

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Summary

This prospective observational study addresses the clinical challenge of determining appropriate indications for computed tomography (CT) in patients with head injuries, particularly given the controversy surrounding CT use in mild head injury cases. The authors aimed to estimate the rate of CT positivity and define specific criteria for performing head CTs in their patient population to balance the risks of missing intracranial injuries against unnecessary radiation exposure. The study was conducted over an eight-month period in the Department of Radiology at FH Medical College, involving 1,000 patients who presented to the emergency department with head injuries. Participants were classified into three groups based on the Glasgow Coma Scale (GCS): mild (GCS 13–15), moderate (GCS 9–12), and severe (GCS ≤8). Data collected included demographic information, mechanism of injury, and clinical features such as loss of consciousness (LOC), vomiting, seizures, and bleeding. Statistical analysis using SPSS software assessed the association between CT positivity and various sociodemographic and clinical factors. The results indicated that 51.2% of the total study population had positive CT findings. The majority of patients were male (80%) and aged 21–40 years (48.2%), with road traffic accidents accounting for 77% of injuries. CT positivity rates varied significantly by injury severity: 37.5% for mild, 80.4% for moderate, and 95.2% for severe head injuries. The study identified statistically significant associations between CT positivity and several factors, including male gender, age over 60, history of alcohol consumption, LOC greater than 5 minutes, vomiting, seizures, ear or nose bleeding, and a GCS score of 12 or lower. Notably, patients with LOC >5 minutes had a 12 times higher likelihood of positive CT findings, while those with alcohol intoxication had a 9 times higher likelihood compared to non-intoxicated patients. The authors conclude that CT is indicated for all patients with moderate and severe head injuries (GCS ≤12). For mild head injury patients, they recommend a low threshold for CT in elderly individuals and those with alcohol intoxication, regardless of GCS. Additionally, CT is advised for mild head injury patients presenting with specific risk factors: LOC >5 minutes, vomiting, seizures, or evidence of ear or nose bleeding. These findings provide evidence-based guidelines to help clinicians identify patients at high risk for intracranial injury, thereby optimizing diagnostic resource utilization and improving patient outcomes.

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