Clinical Predictors of Minor Head Injury Patients Presenting with Glasgow Coma Scale Score of 14 or 15 and Requiring Neurosurgical Intervention

Abstract

Introduction Minor head injury is the most common type of head injury assessed in accident and emergency departments. Emergency physicians have concerns in discharging patients with intracranial injuries which require neurosurgical interventions. The aim of this study is to find out the clinical signs and symptoms which can help to predict who need neurosurgical intervention following minor head injury. Methods This was a retrospective case-control study. Patients with head injury and GCS score of 14 or 15 and requiring neurosurgical intervention were recruited. Another group of patients with head injury and GCS score of 14 or 15 but not requiring neurosurgical intervention were enrolled as control. In all cases, clinical signs and symptoms were collected by chart review of the clinical records retrieved by the computerized Clinical Data Analysis & Reporting System (CDARS). The relationship between clinical features and need of neurosurgical intervention was analyzed by chi-square test with 95% confidence interval. Results A total of 22 cases were found and compared with 288 controls to study on the clinical variables for the prediction of the need of neurosurgical intervention. Six warning signs were found statistically significant by univariate analysis: severe headache (p=0.0206), vomiting more than once (p<0.0006), drop in GCS (p<0.0001), confusion/restlessness (p<0.0001), bleeding from ear (p<0.0001) and skull fracture in the X-ray (p<0.0001). Conclusion Patients with minor head injury presenting with GCS score of 14 or 15 to the accident and emergency department rarely require neurosurgical intervention. Some clinical risk factors can be used as a guide to identify those who need neurosurgical intervention following minor head injury.