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KMID : 0385919940050010005
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Journal of the Korean Society of Emergency Medicine
1994 Volume.5 No. 1 p.5 ~ p.16
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The Value of Computed Tomographic Scans for Patients with Low-Risk Head Injuries
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Abstract
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The determination that a particular head injury is low-risk is usually made clinically. Observation at home or in the hospital has been the usual treatment for such patients. Recent reports of relatively high morbidity among patients with
low-head
injury in other countries suggest the need for advancement in diagnostic criteria. A retrospective review of 1202 patients admitted to Chung Ang Gil Hospital between January 1992 and June 1992 who had a Glasgow coma scale (GCS) score of 13 to 15
on
admission and who experienced a brief loss of consciousness or amnesia after the injury, was performed to evaluate the benefit of computed tomographic (CT) scanning of the head.
In 145.9% of patients abnormalities were seen on the initial CT scan and 5.7% required surgery. Among the 831 patients with GCS 15, 10.3% had abnormalities on the CT scan and 3.4% required neurosurgical operation. In cases of GCS 14, an initial
CT
scan
showed abnormality in 19.5% and 8.1% needed operation. Only 4 of the 1022 patients with normal CT scans on admission showed subsequent deterioration and required operation. These figures suggest that history and that the addition of a CT scan
greatly
imoroves patient assessment. Patients with normal CT scans and with GCS 14 or 15 could be considered for observation at home because their chance of deterioration is so low, allowing hospital personnel to devote their full attention to more
seriously
injured patietns.
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