Table 1.

Risk of Intracranial Injury: Mild Head Trauma

First AuthorCiteYearDesignnEligibility CriteriaOutcomeEstimate
GCS 15, CT Scan Outcomes
Davis91988–1992Case series (post
hoc, CART)
49GCS 15, normal neurologic exam, isolated injury, history LOC/amnesia1-iICH0% (0%–6%)
Dietrich71993Case series195GCS 15iiIntracranial injury5%
Hahn81993Case series549GCS 15Mass lesions (epidural/subdural)7.1%
11Trivial head injuryiiiAbnormal CT scan (intracranial injury)0%
Immordino301986Case series (retrospective)143LOC <5 min, posttraumatic amnesia <1 hSubdural, epidural, or major neuro residual0 (0/143)
Rosenthal31989Case seriesAll patients had LOC <1 h, 90% <5 minIntracranial injury, ½ managed operatively1.3% (.5%–2.8%)
Sekino51981Case series171None or brief LOC
up to 10 min
Outcome = all abnormal CT scans (“small brain lesions”)7.6%
Zimmerman311978Case series24Alert, oriented, minimal or no LOCDeath0 (0/24)
54(Includes adults for this)Focal abnormalityiv22%
Schunk321996Case series216 ≥2 yGCS 15, normal exam who had CT doneIntracranial injury3.2% (7/216)
GCS 15, Clinical Outcomes
Cline1988Case series34GCS 15, normal exam, age <15Clinical deterioration0%
Dacey61986Case series230 childrenAmong GCS 151-v“Required” neurosurgical intervention1.5%vi
Unpublished Data
Finkelstein1994viiCase series134Children 2–15, LOC 0–5 min, normal exam, GCS 15“Significant” abnormal cranial CT scan3.7% (5/134)
Stein1994viiiCase series582Children with closed head injury, GCS 15 plus 1 of: (LOC, amnestic, dazed)Intracranial lesion
Neurosurgical procedure
9.6%
1.9%
Stein1994ixCase series1992Children with closed head injury, GCS 15, diagnosis of “intracranial injury” plus one of {LOC, amnestic, dazed}Intracranial lesion
Neurosurgical procedure
8.2%
5%
GCS >12, Clinical and CT Outcomes, Published
Hennes11988Case series24GCS >12Abnormal CT (intracranial injury)25%1-x
Dahl-Grove401991–1992Case series62GCS >12, mild head injury, normal CT scan (median, 15)Abnormal neurological exam0% (CI: 0%–6%)
Davis41987–1992Case series/
cohort
400xiGCS >12, normal CTa) Admission in subsequent month
b) Neurosurgical intervention
a) 3/399 (1 with intracranial contusion)
b) 0% (CI 0%–.75%)
Rivara21987Case series51GCS >12xiiIntracranial abnormal
 on CT
12%xiii
Sainsbury231984Discharge data35/28 701Cases = symptomatic IC bleeding; denom = all admits Wales for head traumaIntracranial bleeding.12%
Teasdale101990(Community) heterodemic design  34GCS 15 (oriented and alert) age 0–14Intracranial hematoma undergoing surgery.017% (1:5882)
Hendrick33? Case series1500No LOC; includes neonatesExtradural, subdural, and “brain damage”xivabout 9%
  • LOC, loss of consciousness; CI, confidence interval.

  • F1-i Both multiple trauma (7/91) and “abnormal neurologic exam” (5/28) had much higher rates of ICH. No child required evacuation, although 1 multiple trauma and normal exam received intracranial monitoring. Neurologic abnormalities included subsequent disorientation focal weakness, agitation, lethargy/drowsiness.iiAll had either LOC, amnesia, headache, or vomiting; neurological examinations were normal.iiiTermed mild or moderate in article, defined as no history of or findings of altered MS, no headache or persistent vomiting, no seizures or focal deficit, and with or without facial or scalp hematomas, contusions, or laceration.ivContusion, hematoma, subdural, epidural.

  • F1-v Of 90 adults and children in the study 15% had LOC; specific pediatric data on LOC not provided.viThree cases, all age 17–19.viiFinkelstein, Homer, and Kleinman, personal communication, 2/10/94.viiiPersonal communication, February 10, 1994, series from Cooper hospital.ixPersonal communication, February 10, 1994, series from NIDD.

  • F1-x All had either headache or vomiting or impact seizure or LOC >5 minutes.

    xi Three hundred ninety-nine excluding 1 patient who was receiving coumadin; that patient had a subsequent subdural hematoma requiring surgical evacuation.

    xii All “symptomatic,” ie, history of LOC, abnormal LOC in field or ED, or focal neurologic abnormality; cannot differentiate subtypes from data given.

    xiii Increases to 20% if depressed skull fracture included; to 31% if linear skull fracture included.xivBrain damage = contusion, laceration, pulping of the brain, and intracerebral hemorrhage.