Indicators of abnormal CT Scan findings in clinically mild traumatic brain injury patients

Abstract

Background & Objective: Various clinical guidelines have been developed to predict intracranial findings and minimize the unnecessary head CT scans in mild traumatic brain injury (MTBI) patients. However, the most appropriate guideline for routine practices might be highly dependent on the emergency department policies, qualifications of medical staff, and the level of infrastructure availability. This study aims to identify various indicators that can predict abnormal CT scan findings in clinically MTBI patients.

Methods: Our retrospective analytical study included patients diagnosed with MTBI admitted to the Emergency Department of Prof. Dr. R. D. Kandou General Hospital, Manado, Indonesia, from November 2022 to February 2023, age ≥18 years, and having undergone a brain CT scan. Multivariate analyses of several indicators were performed to identify the strongest indicators of abnormal CT scan findings.

Results: Among 112 subjects, abnormal CT scan findings were identified in 38 subjects (33.9%). The proportion of men is greater (63.4%), with a median age of 33 (18-88) years. The most common mechanism was traffic accidents (83.0%). Logistic regression analysis revealed that skull fracture (OR 8.144, 95% CI 3.110-21.326) and signs of skull base fracture (OR 7.059, 95% CI 2.217- 22.475) were the two strongest indicators in predicting abnormal CT scan findings.

Conclusions: Skull fracture and signs of skull base fracture were the two strongest indicators of abnormal CT scan findings in clinically MTBI patients. Therefore, skull X-rays in the setting of limited CT scans and thorough clinical examination are recommended.