USE OF COMPUTED-TOMOGRAPHY OF THE HEAD IN THE HYPOTENSIVE BLUNT-TRAUMA PATIENT

Study objective: To identify patients presenting with hypotension due to blunt trauma who should undergo computed tomography (CT) of the hea d before urgent chest or abdominal operation. Design: Retrospective re gistry-based record review. Setting: Urban Level 1 trauma center. Part icipants: Consecutive trauma patients with suspected head injury, blun t mechanism of injury, and hypotension who were discharged between Jan uary 1, 1989, and December 31, 1991. Patients who were dead on arrival or died within 15 minutes of arrival were judged unsalvageable and ex cluded. Review of 3,224 trauma patients identified 212 as the study po pulation. Frequency of neurosurgical intervention or general surgical intervention within 6 hours of admission and the time required for com pletion of CT of the head were noted. Results: Overall, 40 general sur gical operations (19%) and 16 craniotomies (8%) were performed, with a mortality rate of 18%. Patients with Glasgow Coma Scale scores of les s than 8 had a 19% rate of craniotomy, and those with scores between 8 and 13 had a 9% rate. Sixteen patients had CT before surgery, with an average delay of 68 minutes. No patient who responded to initial resu scitation experienced hemodynamic instability in the CT suite, includi ng 15 patients with positive diagnostic peritoneal lavage. Conclusion: CT scan of the head before general surgical operation appears to be s afe in patients who respond to initial resuscitation. The likelihood o f craniotomy in patients with Glasgow Coma Scale scores of 13 or less is comparable to the likelihood of general surgical operation. Physici ans should be encouraged to make CT of the head a high priority in thi s group.