Defining "therapeutically inconsequential" head computed tomographic findings in patients with blunt head trauma

Annals of Emergency Medicine
Clare AtzemaNational Emergency X-Radiography Utilization Study (NEXUS) II Group

Abstract

Many injuries detected by computed tomographic (CT) imaging of blunt head trauma patients are considered "therapeutically inconsequential." We estimate the prevalence of these findings and determine how frequently affected patients had "important neurosurgical outcomes," defined as either a directed intervention or a poor Glasgow Outcome Scale score. We prospectively enrolled all blunt head trauma patients undergoing emergency head CT imaging at 18 centers participating in the National Emergency X-radiography Utilization Study II (NEXUS). From these cases, we identified all patients whose official CT reading met predefined criteria for "therapeutically inconsequential" injuries. We obtained detailed follow-up information on all such patients at 6 sites, including the need for neurosurgical intervention and Glasgow Outcome Scale scores. Among patients having "important neurosurgical outcomes," we assessed the frequency of 2 potential clinical identifiers: altered mental status and coagulopathy. "Therapeutically inconsequential" head CT findings were present in 155 of 8,374 subjects (1.85%; 95% confidence interval 1.57% to 2.16%). Sites participating in the follow-up study enrolled 81 of these patients, of whom 10 (12%) had "impo...Continue Reading

Citations

Mar 1, 2013·The Western Journal of Emergency Medicine·Cheryl W VanceNathan Kuppermann
Dec 1, 2017·Neurology. Clinical Practice·Laura CampiglioAlberto Priori
Apr 19, 2020·Academic Medicine : Journal of the Association of American Medical Colleges·Adam AmmarDavid Altschul
Jul 22, 2014·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Robert M RodriguezGregory W Hendey
Jan 27, 2018·Molecules : a Journal of Synthetic Chemistry and Natural Product Chemistry·Satoshi YamamotoDonald S Prough
Dec 11, 2007·AJNR. American Journal of Neuroradiology·M SmitsD W J Dippel
Apr 15, 2020·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Michael ZeindlerThomas Gross
Dec 24, 2005·The Journal of Trauma·William R MowerUNKNOWN NEXUS II Investigators
Apr 25, 2018·The Journal of Emergency Medicine·Joseph GraterolRobert M Rodriguez

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