What is the association between the Glasgow Coma Scale score, mechanism of injury and computed tomography findings in neurosurgically relevant head injury patients.
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Background: There is extremely limited literature that provides patterns of CT findings at the various GCS levels, and finding the association between mechanism of trauma and CT findings. Most studies done are on patients with GCS of 13, 14, and 15. In addition there are no South African studies on GCS and mechanism of injury as a predictor of CT findings in head injury patients. This study aims to correlate the GCS presentation and mechanism of injury in neurosurgically relevant patients with CT findings and therefore assist to determine the severity and urgency for which patients should be transferred to regional and tertiary hospitals with imaging and neurosurgical facilities. The hypothesis is that GCS and mechanism of injury can be used to predict CT findings to triage patients into risk categories. Objectives: The objective of this study is to compare patients GCS at presentation, mechanism of injury and CT findings in neurosurgically relevant head injury patients and thus assist clinicians on initial contact to determine the severity of head injury. This is especially relevant in rural areas to determine the severity and urgency for which patients should be transferred to regional and tertiary hospitals. Further objectives include to determine the patterns of CT findings at various GCS ranges, i.e.: GCS 3-6; 6-9; 9-12; 12-15 and to determine the patterns of CT findings in patients with various mechanisms of injuries and compare this to relevant literature. The study should determine the likelihood of various types of CT findings in relation to the GCS and mechanism of injury. Method: A retrospective chart review was done of 100 randomized patients, between the ages of 18 and 65 years, with blunt head trauma seen at Inkosi Albert Luthuli Central Hospital (IALCH) over a one year period. Medical records were analyzed to determine the patients who met the inclusion criteria. In patients with blunt head trauma, the initial GCS, mechanism of injury, CT imaging findings and if neurosurgical intervention was required, were recorded. Results: A total of 100 randomly selected patients were included in this study. From this study, 48% of patients presented to hospital due to assault, 21% from MVA, 12% due to a fall, 17% from PVA and 2% from other uncategorised injuries. From the 100 patients in this study, 15% of patients presented with a GCS between 3-6, 23% between 7-9, 22% between 10-12 and 40% presented with GCS between 13-15. Further assessment showed no significant correlation between GCS at presentation and CT findings in neurosurgically relevant head injury patients (P>0,05). There is furthermore no significant correlation of mechanism of injury and CT findings with the exception of subarachnoid haemorrhage. There is a significant correlation with the presence of subarachnoid haemorrhage on CT and history of assault or pedestrian vehicle accident (P=0,015). Conclusion: There should be a high index of suspicion of intracranial injury in patients with a history of assault or pedestrian vehicle accident. It is advised that patients with history of assault or pedestrian vehicle accident, as a mechanism of injury, receive CT imaging. Due to there being no significant correlation between GCS at presentation and CT findings, a GCS between 13-15 in a patient should not be seen as an exclusion criteria for imaging.