Andrzej Żyluk, Agnieszka Mazur, Bernard Piotuch


Introduction: The objective of the study was an assessment of the occurrence of traumatic cerebral lesions and skull fractures in patients with mild head trauma. A total of 171 patients’ notes, 89 male (52%) and 82 female (48%), mean age 48 years, were subjected to analysis.

Results: Of the 171 patients, in 58 (34%) CT scanning of the head was not performed for various reasons, and these patients were discharged home. Of the remaining 113 persons, who had head CT performed, in 99 (88%) no abnormalities were found; in 10 (9%) CT scans revealed pathological findings unrelated to the trauma: most frequently cortical-subcortical atrophy followed by old post-stroke foci, and in 4 patients (3%) post-traumatic pathologies: skull fractures in 2 and facial bone fractures in 2. Diagnosis of these fractures did not change the conservative treatment of these patients, but only prolonged in-patient stay for 2–3 days. All skull and facial bone fractures occurred in patients who were alcohol intoxicated, were lying, could not maintain vertical position, or who had the “racoon eyes” sign.

Conclusions: The results of our study show that lack of abnormalities in neurological examination in patients after mild head injury is a reliable indicator for omitting CT scanning, because the risk of overlooking brain injuries in these patients is minimal. However, patients who are intoxicated, have problems with maintaining a vertical position and have the “racoon eyes” sign, are likely to have skull or facial fractures, and CT scanning is therefore justified. Considering these precursors (guidelines) and the use of clinical decision rules described in the article may reduce the number of head CT scans performed “just in a case”.


minor head trauma; computed tomography; clinical decision rule

Full Text:

PDF (Język Polski)


Yamaki T., Hirakawa K., Ueguchi T., Tenjin H., Kuboyama T., Nakagawa Y.: Chronological evaluation of acute traumatic intracerebral haematoma. Acta Neurochir (Wien). 1990, 103 (3-4), 112–115.

Rohacek M., Albrecht M., Kleim B., Zimmermann H., Exadaktylos A.: Reasons for ordering computed tomography scans of the head in patients with minor brain injury. Injury. 2012, 43 (9), 1415–1418.

Stippler M., Smith C., McLean A.R., Carlson A., Morley S., Murrau-Krezan C. et al.: Utility of routine follow-up head CT scanning after mild traumatic brain injury: a systematic review of the literature. Emerg Med. 2012, 29 (7), 528–532.

Żyluk A.: Wskazania do tomografii komputerowej w lekkich urazach głowy: przegląd piśmiennictwa. Neurol Neurochir Pol. 2015, 49, 52–57.

Goldberg J., McClaine R.J., Cook B., Garcia V.F., Brown R.L., Crone K. et al.: Use of a mild traumatic brain injury gideline to reduce inpatient hospital imaging and charges. J Pediatr Surg. 2011, 46 (9), 1777–1783.

Żyluk A., Mazur A., Piotuch B., Safranow K.: Analiza wartości objawów klinicznych w przewidywaniu pourazowych zmian w mózgowiu i złamań kości czaszki u chorych z lekkimi i średnimi urazami głowy. Pol Przegl Chir. 2013, 85, 1268–1279.

Miller E.C., Derlet R.W., Kisner D.: Minor head trauma: is computed tomography always necessary? Ann Emerg Med. 1996, 27 (3), 290–294.

Nagy K.K., Joseph K.T., Krosner S.M., Roberts R.R., Leslie C.L., Duffy K. et al.: The utility of head computed tomography after minimal head injury. J Trauma. 1999, 46 (2), 268–270.

Mower W.R., Hoffman J.R., Herbert M., Wolfson A.B., Pollack C.V., Zucker M.I.: Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma. 2005, 59 (4), 954–959.

Stiell I.G., Wells G.A., Vandemheen K., Clement C., Lesiuk H., Laupacis A. et al.: The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001, 357, 1391–1396.

Stiell I.G., Clement C.M., Rowe B.H., Schull M.J., Brison R., Cass D. et al.: Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA. 2005, 294 (12), 1511–1518.

Ibanez J., Arikan F., Pedraza S., Sanchez E., Poca M.A., Rodriguez D. et al.: Reliability of clinical guidelines in the detection of patients at risk following mild head injury: results of a prospective study. J Neurosurg. 2004, 100 (5), 825–834.


Copyright (c) 2015 Andrzej Żyluk, Agnieszka Mazur, Bernard Piotuch

License URL: