Computed Tomography Profile and its Utilization in Head Injury Patients in Emergency Department: A Prospective Observational Study

Context Based on Glasgow Coma Scale (GCS), head injury can be classified as minor (GCS 13-15), moderate (GCS 9-12), and severe (GCS 3-8). There is a lot of controversy in the use of computed tomography (CT) in head injury patients. Aims This study was intended to estimate the rate of CT positivity in head injury patients and to define the criteria for doing CT in head injury patients. Settings and Design This was a prospective observational study in the emergency department (ED) over a 12-month period. Subjects and. Methods Study involved all head injury patients attending ED. Risk factors studied were a loss of consciousness (LOC), vomiting, seizures, ear bleed, nosebleed, external injuries, and alcohol intoxication. Statistical Analysis Used Comparison of CT positivity with the patient's demographics and clinical characteristics was carried out using Chi-square. Results A total of 1782 patients were included in this study. Overall CT positivity was 50.9%. In minor head injury (MHI), CT positivity rate was 38%. The study showed significant association of CT positivity with five variables: LOC >5 min, vomiting, seizures, ear bleed, and nosebleed. Conclusions From the study, we recommend following: CT is indicated in all patients with moderate and severe head injury (GCS ≤12). Low threshold for taking CT is advisable in elderly and alcohol-intoxicated patients. In MHI, CT is indicated if any one of the following risk factors are present: LOC >5 min, history of vomiting, history of seizures, history of ear bleed, and history of nosebleed.