Peri-injury symptomatology as predictors of brain computed tomography (CT) scan abnormalities in mild traumatic brain injury (mTBI)

Sihi Vasista; Josue Saint-Fleur; Neera Kapoor; Latha Ganti

doi:10.1186/s12245-024-00754-7

Peri-injury symptomatology as predictors of brain computed tomography (CT) scan abnormalities in mild traumatic brain injury (mTBI)

Int J Emerg Med. 2024 Nov 5;17(1):171. doi: 10.1186/s12245-024-00754-7.

Authors

Sihi Vasista¹, Josue Saint-Fleur², Neera Kapoor³, Latha Ganti^{4

5}

Affiliations

¹ Seminole High School, Sanford, FL, USA.
² Orlando College of Osteopathic Medicine, Winter, FL, 34787, USA.
³ New York University's Grossman School of Medicine, New York, NY, 10016, USA.
⁴ Orlando College of Osteopathic Medicine, Winter, FL, 34787, USA. lganti@ocom.org.
⁵ Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, USA. lganti@ocom.org.

Abstract

Objective: This study aimed to identify predictors of brain CT abnormalities in patients who sustained a mild traumatic brain injury (mTBI).

Methods: Retrospective observational cohort of adult patients with mTBI (Glasgow Coma Score 13-15) that occurred within the preceding 24 h.

Results: 2548 (91%) of the cohort had a brain CT and 698 (27%) demonstrated abnormal findings. The most frequently observed CT abnormalities were bleeding (638, 25%) and fractures (190, 7.4%). Multivariate logistic regression analysis revealed several significant predictors associated with the presence of brain CT abnormalities including older age [P < 0.0001], male sex [P < 0.0001], loss of consciousness [P = 0.0041], associated vomiting [P = 0.0011], alteration of consciousness (AOC) [P = 0102], and GCS score [P < 0.0001]. This was a robust model with an R² of 14.2%.

Conclusion: In this retrospective analysis, older age, male sex, the presence of loss of consciousness or alteration in consciousness, lower GCS score, and associated vomiting were found to be significant predictors of having an abnormal brain CT. These findings highlight the importance of considering these factors when determining the necessity of brain CT scans in patients with mTBI and suggest that existing clinical decision rules may be limited. These findings may also help to inform clinical decision rules. Early identification of individuals at a higher risk of CT abnormalities may assist in appropriate management and allocation of healthcare resources.

Keywords: Brain CT; Clinical decision rules; Mild TBI.