Failure of the miller criteria to predict significant intracranial injury in patients with a glasgow coma scale score of 14 after minor head trauma

James F Holmes Jr, Mark E. Baier, Robert W. Derlet

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

Objective: To determine the utility of the Miller criteria (presence of headache, nausea, vomiting, and signs of depressed skull fracture) for 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 prospective, consecutive series of all patients undergoing head CT scans with a GCS of 14 following head trauma. A data sheet was completed for all patients prior to obtaining a head CT scan. Results: 264 patients were entered into the study and 35 patients were found to have traumatic abnormalities on head CT scan. The use of the Miller criteria to select those patients who would require head CT scan would have resulted in missing 17 of the 35 abnormal scans, including 2 patients who required neurosurgical intervention. These 2 patients were markedly intoxicated upon presentation. Conclusion: The use of the Miller criteria as the only criteria for screening patients with a GCS of 14 after minor head trauma who require a head CT scan is not recommended. While the authors have identified ethanol intoxication as one confounding factor, further refinement of this risk-stratification tool is required.

Original languageEnglish (US)
Pages (from-to)788-792
Number of pages5
JournalAcademic Emergency Medicine
Volume4
Issue number8
StatePublished - 1997

Keywords

  • Computed tomography
  • Decision rule
  • Glasgow Coma Scale score
  • Head injury
  • Outcome
  • Practice guideline

ASJC Scopus subject areas

  • Emergency Medicine

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