CT Scanning in Minor Head Injury

Head injury is one of the most prevalent events accounting for about one million of emergency visits in US and UK annually. It occurs in over the 50% of traumatic patients and is the leading cause of death and disabilities in children and younger adults all over the world (Holmes, et al., 2006; Kraus & Nourjah, 1998; Langlois, et al., 2006). Annually, traumatic brain injuries cause 435000 emergency department visits, 37000 hospital admissions, and 2685 deaths among children whose ages range from 0 to 14 in the USA (Jager et al., 2000; Langlois et al.,2004). While there has been an increase in the number of CT performed for traumatic patients, particularly those with a suspected head injury, different studies have estimated the prevalence of significant intracranial lesions on a CT to be something between 0.7% and 20% (Bordignon & Arruda 2002, Holmes et al., 2006, Mower 2005, Stiell 2001). Because most of these patients have insignificant injuries requiring no specific therapy, some authorities are reluctant to advocate CT studies in all such patients. In contrast, other authorities, concerned with the potentially dramatic consequences of a missed finding, tend to encourage the liberal use of brain CT in such patients bringing an estimated 750 million $ cost for health system (Borczuk, 1995; Jeret et al., 1993; Schynoll et al., 1993); however, it has been reported that reduction in the number of patients complicated due to head trauma is happening as a result of better control of developing seizure or raised intracranial pressure (Klauber et al. 1989). The majority of treated brain injuries are categorized as mild head injury (MHI) (Kraus & Nourjah,1988). While patients with moderate to severe head injury usually show obvious clinical signs, simplifying the decision to perform a head CT scan, there are controversies in the indications of CT scanning in MHI patients considering the fact that most of these patients represent minimal intracranial lesions, requiring no specific therapy (Shackford et al., 1992). This chapter will recap the application of CT scanning in MHI patients in adults and children.