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J Korean Soc Emerg Med > Volume 5(2); 1994 > Article
Journal of The Korean Society of Emergency Medicine 1994;5(2): 202-208.
A HIGH-YIELD CLINICAL VARIABLE FOR BRAIN CT SCAN IN HEAD INJURED PATIENTS
Sung Wook Choi, Dae Kon Sohn, Hahn Shick Lee
Department of Emergency Medicine, YongDong Severance Hospital, YUMC
  Published online: December 31, 1994.
ABSTRACT
A retrospective analysis by chart review of consecutive 136 patients with head trauma, dur­ing period of 2 months from Jan. 1st. 1994 to Feb. 28th. 1994. who visited YDSH ED. All pa­tients underwent brain CT scan to rule out intracranial lesion at the time of initial ED visit. The purpose of this study is to determine which clinical paramedters can be used effectively to select patients requiring brain CT scan after an event of head trauma. The results were as follows : 1. Consecutive 136 cases of head trauma patients who had taken brain CT scan. Mean age was 31.1 years old. There were higher incidence of intracranial lesion developed in over sixty year old. 2. Pedestrian accident was most common cause of injury ( 42.0% ), followed by MVA ( 25.7 % ) and falling down injury ( 23.1% ) 3. There were 12 symptomatic variables and 8 sign variables and among variable with more than 50 % positive in brain CT scan was selected to be high-yield clinical variable. 9 high-yield clinical variables were selected and they are : ① abnormal Babinski sign (100% ) ② anisocoria and/or fixed dilated pupil(90.5%) ③ basal skull Fx. sign(84.6%) ④ positive focal neurologic sign(80.0%) ⑤ GCS less than 15 point(78.6%) ⑥ antegrade amnesia(66.7%) ⑦ prolonged LOC(65.9%) ⑧ mental change(52.1%) ⑨ alcohol intoxication(50.0%) This study suggest that significant number of patients with head trauma for brain CT can be effectively reduce by using high-yield clinical criteria. Use of these criteria requires thorough and complete history taking and neurologic examination, possible intoxication by an alsohol and antegrade memory loss. There were no surgical lesion missed in this study, but this protocol can­ not assure that such lesion would be missed. The further prospective evaluation using this clinical variable is required to confirm the results.
Key words: head trauma, brain CT scan, high-yield clinical variable.
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