Combined head and abdominal computed tomography for blunt trauma: Which patients with minor head trauma benefit most?

Sarah R. Wu, Shamim Shakibai, John P McGahan, John R Richards

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

The widespread availability of computed tomography (CT) in the diagnosis and management of blunt trauma has created the possibility of overuse without clear indications. Some clinicians believe that patients with head injury, intoxication, and/or distracting injury have an unreliable abdominal examination and should undergo combined head and abdomen CT. The objective of this study was to evaluate which patients with minor head trauma benefit most from combined head and abdomen CT. Consecutive blunt trauma patients, with a Glasgow coma scale (GCS) of 14 or 15, who underwent concomitant head and abdomen CT upon admission to a level I trauma center over a 2-year period were retrospectively reviewed. Patient demographics, mechanism of injury, physical exam, hospital course, and radiological and laboratory findings were recorded. Patients were divided into four subgroups based upon the presence or absence of intracranial and/or intraabdominal injury detected by CT. Among the 1,478 blunt head trauma patients, only 18 (1%) patients had both head and abdominal injuries detected by combined CT. One-hundred twelve (8%) patients had only head injuries, and 131 (9%) had only intraabdominal injuries detected. Patients with a GCS of 14 were more likely to have isolated head injury [odds ratio (OR) 3.1, P=0.001], while those with loss of consciousness were more likely to have combined head and intraabdominal injury (OR 6.8, P=0.03) or isolated head injury (OR 1.7, P=0.02). Abdominal tenderness was associated with increased risk of isolated intraabdominal injury (OR 1.8, P=0.0015). Hematuria was associated with increased risk of combined head and intraabdominal injury (OR 8.3, P=0.0004) or isolated intraabdominal injury (OR 7.9, P=0.0001). Patients with loss of consciousness and/or GCS of 14 frequently undergo head CT. The addition of an abdomen CT scan in this patient population should be based on objective clinical criteria such as presence of abdominal tenderness and/or hematuria.

Original languageEnglish (US)
Pages (from-to)61-67
Number of pages7
JournalEmergency Radiology
Volume13
Issue number2
DOIs
StatePublished - Nov 2006

Fingerprint

Craniocerebral Trauma
Head
Tomography
Wounds and Injuries
Odds Ratio
Abdomen
Glasgow Coma Scale
Unconsciousness
Hematuria
Abdominal Injuries
Trauma Centers
Demography

Keywords

  • Abdomen
  • Computed tomography
  • Head injury
  • Trauma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Combined head and abdominal computed tomography for blunt trauma : Which patients with minor head trauma benefit most? / Wu, Sarah R.; Shakibai, Shamim; McGahan, John P; Richards, John R.

In: Emergency Radiology, Vol. 13, No. 2, 11.2006, p. 61-67.

Research output: Contribution to journalArticle

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