Use of a complete neurological examination to screen for significant intracranial abnormalities in minor head injury

Indications for head computed tomography (CT) scans are unclear in patients with nonpenetrating head injury and Glasgow Coma Scale (GCS) scores of 15, We performed a prospective study to determine if significant intracranial injury could be excluded in patients with GCS-15 and a normal complete neur ological examination. A prospective trial of clinically sober adult patient s with GCS = 15 on emergency department (EO) presentation after closed head injury with loss of consciousness or amnesia was conducted from May 1996 t hrough April 1997, All subjects underwent a standardized neurological exami nation including mental status evaluation, and assessment of motor, sensory , cerebellar and reflex function before CT scan. During the study period, 5 8 patients met inclusion criteria, Fifty five patients (95%) had normal CT scans and 23 (42%) had focal neurological abnormalities. Three patients (5% ) had CT scan findings of acute intracranial injury, two of whom had normal neurological examinations, One patient had an acute subdural hematoma requ iring emergent surgical decompression; the other had both an epidural hemat oma and pneumocephalus that did not require surgery. Significant brain inju ry and need for CT scanning cannot be excluded in patients with minor head injury despite a GCS = 15 and normal complete neurological examination on p resentation, (Am J Emerg Med 2000;18:159-163, Copyright (C) 2000 by W.B. Sa unders Company).