MILD HEAD-INJURY - DIFFERENCES IN PROGNOSIS AMONG PATIENTS WITH A GLASGOW-COMA-SCALE SCORE OF 13 TO 15 AND ANALYSIS OF FACTORS ASSOCIATED WITH ABNORMAL CT FINDINGS

We performed a retrospective study of 2484 consecutive patients with m ild head injury (Glasgow Coma Scale score 13-15) who were seen during a period of 18 months. Of these, 2351 (94.6%) patients scored 15 point s, 88 (3.5%) scored 14 points and 45 (1.3%) 13 points. A multivariate analysis showed that advanced age, a lower GCS (13-14) and the presenc e of skull fracture, and focal signs, significantly increased the inci dence of abnormal computed tomography (CT) findings. By contrast, the gender, the mechanism of injury, the occurrence of initial loss of con sciousness, posttraumatic amnesia and coagulation disorders did not si gnificantly increase the incidence of abnormal CT findings. Patients w ith 13-14 GCS had a significantly higher incidence of initial loss of consciousness, of skull fracture, abnormal CT findings, need for hospi tal admission, delayed neurological deterioration and need for operati on than patients with a GCS of 15. Thus, we suggest separating patient s with a GCS of 13-14 into a different category and recommend performi ng CT in all those not improving within 4-6 h of injury. Such a policy makes skull radiography unnecessary in this subgroup. By contrast, sk ull radiographs may be useful for the triage of patients with a GCS of 15 that represent most of the mild head injury cases; radiographs sho uld be obtained in patients presenting with initial loss of consciousn ess or posttraumatic amnesia (27.9% of the total cases) as these two f indings were associated with a significantly higher incidence of fract ure. Patients without these two findings (72.1% of the cases) showed a very low incidence of skull fracture (0.9% in this study) and may be discharged home with a warning sheet.