Summary of case reports of mild head injury patients with GCS 15 where an early CT scan might have been normal and the patient still deteriorated within two days
Author, year, country, reference | Type of study | Patient, history | Time of first CT, result | Reason for new CT | Time for new CT, result | Intervention, outcome | Number of cases, remarks |
---|---|---|---|---|---|---|---|
Hemphill, 1999 USA,26 | Retrospective case series of 194 patients with late complications | 74 year old male, fall, salicylate therapy, no LOC or amnesia, no other symptoms | Early, normal | Returns 23 hours later, comatose, GCS 3 | After 25 hours, subdural hematoma | Unclear, died | 1 “false negative” case, symptom free at start, salicylate therapy |
Domenicucci, 1995, Italy,27 | Review article with 5 original and 45 earlier published cases | 31 year old woman, normal neurology after car accident | After 4 hours, normal | Depressed level of, consciousness, anisicoria, right sided weakness | After 21 hours, intracranial bleeding | Surgery, discharged to home after10 days | 1 ”false negative” case, few details given |
Ciquini Junior, 1992 Brazil,28 | Case report of two cases | 10 year old boy, fell from >2 metres, normal neurology | After 3 hours, normal | GCS lowered to 14 | After 21 hours, extradural haematoma | Surgery, discharged to home after 5 days | 1 “false negative” case, had both skull radiograph and CT, unclear why admitted after first CT |
Culotta, 1996 USA,21 | Retrospective case series of 3370 patients with GCS 13–15 | Six cases, no other history given, GCS 15 | “Early”, normal | Not stated | Not stated | Surgery, unclear | 6 possible cases, few details given, unclear time intervals. No further data delivered on request. |
Keskil, 1995 Turkey 29 | Retrospective case series of 257 children with GCS 14–15 | 6 year old boy, GCS 15 | Unclear, not stated | Clinical deterioration after 2 days | After 2 days, diffuse cerebral swelling | Unclear, died | 1 possible case, unclear if initial CT was carried out |
Arienta, 1997 Italy, 30 | Retrospective case series of10000 head injuries | Patient with epilepsy admitted for observation, GCS 15 | Early, normal | Clinical deterioration | Unclear, intracranial haemorrhage | Unclear, unclear | 1 possible case, few details given, unclear time intervals |
Total | 11 cases |