Moderate Head Injury: Predictors of a Repeat CT Scan

Oh, Yong Hae; Kim, Gab Teug

Abstract

PURPOSE: A moderate head injury (Glasgow coma scale 9-13) has the large variability of severity, which accounts for the wide variability in the progression of lesions and in outcomes. Computed tomography (CT) is the standard diagnostic method for head injury, and repeat CTs (RCTs) are often obtained in order to monitor for progression of intracranial lesions. The purpose of this study was to suggest guidelines for RCT for moderate head injury.
METHODS
In this study we reviewed data for 219 patients with moderate head injury who were admitted to our hospital via the emergency department between January 2004 and December 2009. The main outcome was worse progression of the intracranial lesions on RCT and neurosurgical intervention. Univariate and multivariate analyses were done for clinical variables to identify risk factors for progression of intracranial lesions and neurosurgical operations.
RESULTS
On RCT, progression of injury was seen in 30.1% of patients, and neurosurgical intervention was performed in 14.6% of patients. Sixty percent of CT progression and ninety percent of neurosurgical intervention were occurred in patients with neurological deterioration. Independent risk factors associated with neurosurgical operation were coagulopathy (OR=13.275), amount of intracranial hemorrhage (OR=8.539), Marshall diffuse injury type of III/IV (OR=4.455), and skull fracture (OR=4.495).
CONCLUSION
Routine repeat CT is necessary within 6 hour and 24-48 hour post-injury in patients with moderate head injury and without neurological deterioration.