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AJNR - American Journal of Neuroradiology

Published ahead of print on December 7, 2007
doi: 10.3174/ajnr.A0852

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American Journal of Neuroradiology 29:506-513, March 2008
© 2008 American Society of Neuroradiology

BRAIN

Outcome after Complicated Minor Head Injury

M. Smits^a, M.G.M. Hunink^a,b,d, D.A. van Rijssel^a,b, H.M. Dekker^e, P.E. Vos^f, D.R. Kool^g, P.J. Nederkoorn^h, P.A.M. Hofmanⁱ, A. Twijnstra^j, H.L.J. Tanghe^a and D.W.J. Dippel^c

^a Department of Radiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
^b Department of Epidemiology and Biostatistics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
^c Department of Neurology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
^d Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass
^e Department of Radiology, University Medical Center Nijmegen St. Radboud, Nijmegen, the Netherlands
^f Department of Neurology, University Medical Center Nijmegen St. Radboud, Nijmegen, the Netherlands
^g Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
^h Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
ⁱ Department of Radiology, University Hospital Maastricht, Maastricht, the Netherlands
^j Department of Neurology, University Hospital Maastricht, Maastricht, the Netherlands

Please address correspondence to Diederik W.J. Dippel, MD, Department of Neurology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; e-mail: d.dippel{at}erasmusmc.nl

BACKGROUND AND PURPOSE: Functional outcome in patients with minor head injury with neurocranial traumatic findings on CT is largely unknown. We hypothesized that certain CT findings may be predictive of poor functional outcome.

Materials and METHODS: All patients from the CT in Head Injury Patients (CHIP) study with neurocranial traumatic CT findings were included. The CHIP study is a prospective, multicenter study of consecutive patients, 16 years of age, presenting within 24 hours of blunt head injury, with a Glasgow Coma Scale (GCS) score of 13–14 or a GCS score of 15 and a risk factor. Primary outcome was functional outcome according to the Glasgow Outcome Scale (GOS). Other outcome measures were the modified Rankin Scale (mRS), the Barthel Index (BI), and number and severity of postconcussive symptoms. The association between CT findings and outcome was assessed by using univariable and multivariable regression analysis.

RESULTS: GOS was assessed in 237/312 patients (76%) at an average of 15 months after injury. There was full recovery in 150 patients (63%), moderate disability in 70 (30%), severe disability in 7 (3.0%), and death in 10 (4.2%). Outcome according to the mRS and BI was also favorable in most patients, but 82% of patients had postconcussive symptoms. Evidence of parenchymal damage was the only independent predictor of poor functional outcome (odds ratio = 1.89, P = .022).

CONCLUSION: Patients with neurocranial complications after minor head injury generally make a good functional recovery, but postconcussive symptoms may persist. Evidence of parenchymal damage on CT was predictive of poor functional outcome.