Journal of Emergencies, Trauma, and Shock
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Year : 2020  |  Volume : 13  |  Issue : 2  |  Page : 135-141

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

1 School of Medicine, New York Medical College, Valhalla, NY 10595, USA
2 Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, USA
3 Department of Surgery, Westchester Medical Center; Department of Surgery, New York Medical College, Valhalla, NY 10595, USA

Correspondence Address:
Rifat Latifi
100 Woods Road, Taylor Pavilion Suite #353, Valhalla, NY 10595
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JETS.JETS_74_19

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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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