Study of skull X-ray and physical examination in head trauma with GCS=15

Abstract

Head trauma is a frequent and important problem from the view of emergency physician. Estimates of mortality following head injury vary from 10 to 36 per 100000 populations. Estimates of combine medical costs from trauma places of over 6 billion dollars. One of the diagnostic procedures in these cases is use of radiologic imaging. Nevertheless, visible fractures are found less than 5% in skull X-Ray films. Therefore, it is better to use this procedure when risk of detecting visible fracture is high. In a cross-sectional analytic study that performed in Emergency Medicine Department of Tabriz University of Medical Sciences from September 2010 to July 2013 on patients with head trauma, we evaluated fractures visible on plain radiographies and the clinical manifestations in patients with head traumas with GCS=15. This study besides determination of relative frequency of age, sex, etiology, visible fracture in skull X-ray and clinical manifestations in these cases tries to determine the relationship between clinical manifestations and visible fracture in skull X-ray. The most common cause of head trauma was falling down 42.7%. Male to female ratio was 2.2 to 1 and most of cases were in 2-17 years age group(40.2%). 346 of cases discharged without admission who had not clinical manifestation or had only slight swelling, mild pain in traumatized area, vomiting(maximally 2 times), scalp wound, cephalohematoma or mind subgaleal hematoma. 150 caese were admitted and 11 of whom had visible fracture in skull X-Ray. Clinical manifestation in these cases are as below. On the basis of this findings and clinical statistical finding in inpatients and usage of Chi-squre with p<0.05 it is proved that there is relationship between clinical manifestations and visible fracture in skull X-Ray. Clinical manifestations include otorrhagia, recurrent vomiting, Raccon sign, and all of the cases who had severe tenderness and subgaleal hematoma had fracture in skull X-Ray. As a conclusion besides these problems, if scalp wound presents, it is preferred to take skull X-Ray to detect foreign body or fracture that have a high risk for meningitis. When cases had no clinical manifestations or had only slight swelling, mild pain, vomiting (maximallt two times) cephalohematoma, or mild subgaleal hematoma, they have had a low risk to find visible fracture and skull X-Ray does not help to determine fracture. Therefore, we can with attending above mentioned notes decrease accomplish side effects and cost of radiology. Other clinical manifestations such as otorrhea and rhinorrhea in studied cases were not found so it demands more study on these line.