The effectiveness of clinical risk factors on determining delayed traumatic intracranial pathology in the treatment of mild head trauma

Abstract

Background: Currently, a large burden of hospital admissions is related to minor head trauma and its related imaging studies. One of the challenging issues for emergency physicians is head computed tomography scan. Objective: The aim of this study was to determine whether there are clinical risk factors that may reveal the intracranial pathology occurring after discharge in adult patients who underwent computerized tomography because of mild/minor head traumas. We aimed to evaluate the prevalence of abnormal computerized tomography in these patients. Methods: Between January 2013 and December 2017 medical records and imaging findings of patients over 18 years of age who had undergone computerized tomography examination in the emergency department of our hospital were evaluated retrospectively. Patients were divided into groups according to age, sex, symptoms and physical examination findings. The relationship between these findings and abnormal computerized tomography findings was evaluated statistically. Results: A total of 619 patients who were admitted to the emergency department for the second time because of the same head trauma and underwent control head computerized tomography were included in the study. Abnormal head computerized tomography findings were found in 7.6% (47) of the patients. Clinical risk factors; Glasgow Coma Scale score, vomiting, loss of consciousness, dangerous trauma mechanism and anticoagulant drug use were significantly correlated with the presence of pathology on head CT( p<0.05). Conclusion: Patients who are readmitted to the emergency department due to worsening symptoms after the injury and who undergo control head computerized tomography have the risk of traumatic brain injury as much as those who are admitted for the first time. A very early computerized tomography may cause to miss an evolving bleeding. The presence of one or more of the identified risk factors will help clinicians to decide which patient requires computerized tomography.