Inadequacy of bedside clinical indicators in identifying significant intracranial injury in trauma patients.

During 1987 and 1988, the trauma service at Hahnemann University Hospital, a level I trauma center, evaluated 1,875 consecutive patients. Four hundred ninety-seven consecutive computed tomographic (CT) scans were performed to evaluate intracranial trauma in the emergency department. These patients' records were reviewed to determine the adequacy of loss of consciousness, amnesia, Glasgow Coma Scale (GCS) score, and mechanism of injury in predicting intracranial findings. In 302 patients with a GCS score of 13 or greater, 55 (18%) CT scans showed abnormal findings. Eleven (4%) of these patients required neurosurgical intervention. Furthermore, patients with normal CT scans required no interventions for head trauma. Mechanism of injury directly influenced the incidence of neurosurgical intervention. Current bedside methods to evaluate patients for possible intracranial injury in our trauma patient population are inadequate. Emergency department CT scans should be performed on all patients referred to the trauma service with previously classified mild- or low-risk criteria for intracranial trauma, regardless of GCS score.