FAILURE OF THE MILLER CRITERIA TO PREDICT SIGNIFICANT INTRACRANIAL INJURY IN PATIENTS WITH A GLASGOW COMA SCALE SCORE OF 14 AFTER MINOR HEAD TRAUMA

Objective: To determine the utility of the Miller criteria (presence o f headache, nausea, vomiting, and signs of depressed skull fracture) f or predicting the need for CT in patients with minor head trauma and a Glasgow Coma Scale score (GCS) of 14. Methods: The study was a prospe ctive, consecutive series of all patients undergoing head CT scans wit h a GCS of 14 following head trauma. A data sheet was completed for al l patients prior to obtaining a head CT scan. Results: 264 patients we re entered into the study and 35 patients were found to have traumatic abnormalities on head CT scan, The use of the Miller criteria to sele ct those patients who would require head CT scan would have resulted i n missing 17 of the 35 abnormal scans, including 2 patients who requir ed neurosurgical intervention. These 2 patients were markedly intoxica ted upon presentation. Conclusion: The use of the Miller criteria as t he only criteria for screening patients with a GCS of 14 after minor h ead trauma who require a head CT scan is not recommended, While the au thors have identified ethanol intoxication as one confounding factor, further refinement of this risk-stratification tool is required.