PRACTICAL SELECTION CRITERIA FOR NONCONTRAST CRANIAL COMPUTED-TOMOGRAPHY IN PATIENTS WITH HEAD TRAUMA

Study objective: To study patients with acute trauma retrospectively f or clinical predictors of positive cranial computed tomography. Method s: We reviewed the medical records and noncontrast computed tomography scans of 373 consecutive head trauma patients presenting to a trauma Level I emergency department. Potential criteria for patient selection were analyzed statistically, using both univariate and multivariate m odels. Results: Our data suggest that relying on four variables-positi ve neurologic examination, intoxication, and a history of amnesia or f ocal neurologic deficit-as screening criteria for computed tomography would have saved 58.6% of the scans performed on these patients. Toget her, these criteria had a sensitivity of 90.1 % and a negative predict ive value of 98.1 % for abnormal computed tomography. Four patients wi th positive scans would not have been detected using this strategy. No ne of these patients deteriorated clinically or required operative int ervention. Conclusion: Our data suggest that it may be possible to eff ectively screen patients with head trauma for cranial computed tomogra phy using clinical criteria and so reduce the current number of scans performed by more than half. However, a prospective study is required to confirm our results.