Clinical Characteristics Predict the Yield of Head Computed Tomography Scans Among Intoxicated Trauma Patients: Implications for the Initial Work-up
Background and Aims: Alcohol intoxication may confound the clinical assessment of the trauma patient. Head computed tomography (h-CT) is the standard imaging technique to rule out intracranial injury in most intoxicated trauma patients. The objective of this study was to determine whether certain clinical findings (computed clinical score [CCS]) could predict the h-CT yield, admission, and neurosurgical consultation (NSC) among intoxicated trauma patients.
Materials and Methods: This is a 4-year retrospective cohort study (2013-2017) of trauma patients who presented to our level 1 trauma center emergency department with alcohol intoxication. For each patient, a computed clinical score (CCS) was generated based on the following findings: age ≥50 years, Glasgow Coma Scale
Results: We identified 437 intoxicated trauma patients (median age: 35 years [interquartile range: 25-50]; 71.9% men; median blood alcohol content: 207.8 mg/dL). One hundred and twenty-four (30.4%) patients had acute findings on h-CT, 351 (80.3%) were admitted, and 112 (25.6%) received NSC. On multivariate analysis, CCS was the only predictor of acute h-CT (odds ratio [OR] =1.6; 95% confidence interval [CI]: 1.3-2.0;
Conclusions: One-third of intoxicated trauma patients have acute findings on h-CT. While the CCS was the best predictor of acute h-CT findings, hospital admission, and NSC, h-CT scanning should continue to be a standard of care.
McIntyre, M. K., Kumar, N. S., Tilley, E. H., Samson, D. J., & Latifi, R. (2020). Clinical Characteristics Predict the Yield of Head Computed Tomography Scans Among Intoxicated Trauma Patients: Implications for the Initial Work-up. Journal of Emergencies, Trauma, and Shock, 13 (2), 135-141. https://doi.org/10.4103/JETS.JETS_74_19