PURPOSE: To assess the utilization of non-contrast head computed tomography (HCT) in clinically stable patients who were involved in motor vehicle collisions. Our goal is to identify patients in whom HCT may be safely excluded without altering clinical outcome. METHODS: Adult, front-seat passengers were retrospectively examined. All clinically stable patients involved in motor vehicle collisions and who subsequently underwent HCT were studied to determine the factors that increased the statistical likelihood of a negative examination. Seven factors relevant to passenger safety or clinical outcomes were measured. RESULTS: Eighteen of the 206 patients who met criteria for our study had positive HCT findings. Front-seat passengers were more likely to suffer traumatic head injury than drivers. Both Glasgow Coma Scale (GCS) and Injury Severity Score (ISS) individually had statistically significant correlations with positive HCT findings. Thirteen of the 18 patients had GCS scores of 13-15. Seatbelts, rollover collisions, gender, and airbag deployment demonstrated relatively decreased predictive values. CONCLUSION: The ISS emerged as the single most reliable predictor of positive HCT findings. Regarding multiple variable effects, the combinations of ISS and patient position or GCS and patient position are the most statistically significant clinical factors in identifying patients in whom HCT may be safely excluded.
PURPOSE: To assess the utilization of non-contrast head computed tomography (HCT) in clinically stable patients who were involved in motor vehicle collisions. Our goal is to identify patients in whom HCT may be safely excluded without altering clinical outcome. METHODS: Adult, front-seat passengers were retrospectively examined. All clinically stable patients involved in motor vehicle collisions and who subsequently underwent HCT were studied to determine the factors that increased the statistical likelihood of a negative examination. Seven factors relevant to passenger safety or clinical outcomes were measured. RESULTS: Eighteen of the 206 patients who met criteria for our study had positive HCT findings. Front-seat passengers were more likely to suffer traumatic head injury than drivers. Both Glasgow Coma Scale (GCS) and Injury Severity Score (ISS) individually had statistically significant correlations with positive HCT findings. Thirteen of the 18 patients had GCS scores of 13-15. Seatbelts, rollover collisions, gender, and airbag deployment demonstrated relatively decreased predictive values. CONCLUSION: The ISS emerged as the single most reliable predictor of positive HCT findings. Regarding multiple variable effects, the combinations of ISS and patient position or GCS and patient position are the most statistically significant clinical factors in identifying patients in whom HCT may be safely excluded.
Authors: S R Shackford; S L Wald; S E Ross; T H Cogbill; D B Hoyt; J A Morris; P A Mucha; H L Pachter; H J Sugerman; K O'Malley Journal: J Trauma Date: 1992-09