Journal of Emergencies, Trauma and Shock (Jan 2020)

Clinical characteristics predict the yield of head computed tomography scans among intoxicated trauma patients: Implications for the initial work-up

  • Matthew K McIntyre,
  • Nikathan S Kumar,
  • Elizabeth H Tilley,
  • David J Samson,
  • Rifat Latifi

DOI
https://doi.org/10.4103/JETS.JETS_74_19
Journal volume & issue
Vol. 13, no. 2
pp. 135 – 141

Abstract

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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 <13, evidence of trauma above the clavicles, amnesia, loss of consciousness, headache, vomiting, and seizures. The primary endpoints were NSC, admission, and acute h-CT finding. Univariate and multivariate regressions were used to compare predictors of the primary endpoints. 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;P < 0.0001) and the best predictor of admission (OR = 1.6; 95% CI: 1.3–1.9;P < 0.0001) and NSC (OR = 1.8; 95% CI: 1.5–2.3;P < 0.0001). 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.

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