Fabbri et al developed scores using parameters from the Neurotraumatology Committee of the World Federation of Neurosurgical Societies (NCWFS) for identifying mild head injury in an adult (see previous section). This can help identify patients who may require a more careful evaluation and closer monitoring. The authors are from Azienda Unita Sanitaria Locale di Forli, Azidena Unita Sanitaria de Cesena and Universita degli Studi di Bologna in Italy.
Inclusion criteria: patient >= 10 years of age with minor, mild or trivial head injury
Exclusion criteria: Glasgow coma score <= 13
Adverse outcome measures:
(1) post-traumatic lesion
(2) need for neurosurgical intervention
(3) severe disability at 6 months
(4) permanent vegetative state at 6 months
(5) death
Parameters:
(1) Glasgow coma score (GCS)
(2) presence of clinical findings
(3) presence of neurological deficits
(4) evidence of skull fracture
(5) presence of risk factors
Clinical findings - one or more of the following:
(1) amnesia
(2) diffuse headache
(3) vomiting
(4) loss of consciousness
Risk factors - one or more of the following:
(1) presence of a coagulopathy (including anticoagulation therapy)
(2) age > 60 years
(3) history of previous neurosurgery
(4) pre-trauma epilepsy
(5) alcohol and/or drug abuse
|
Parameter
|
Findings
|
Points
|
|
clinical findings
|
0
|
0
|
|
|
>= 1
|
1
|
|
risk factors
|
0
|
0
|
|
|
>= 1
|
1
|
|
neurological deficit
|
absent
|
0
|
|
|
present
|
1
|
|
skull fracture
|
absent
|
0
|
|
|
present
|
1
|
score for post-traumatic lesion =
= (3.434 * (points for skull fracture)) + (2.463 * (15 - (Glasgow coma score))) + (1.461 * (points for clinical findings)) + (0.79 * (points for risk factors)) + (0.64 * (points for neurological deficits))
score for neurological intervention =
= (2.404 * (points for skull fracture)) + (2.620 * (15 - (Glasgow coma score))) + (1.077 * (points for clinical findings)) - (0.807 * (points for risk factors))
score for unfavorable outcome =
= (2.352 * (points for skull fracture)) + (2.486 * (15 - (Glasgow coma score))) + (1.448 * (points for risk factors)) + (1.076 * (points for neurological deficits))
Interpretation:
• minimum for all post-traumatic and unfavorable outcome scores: 0
• minimum for neurological intervention: -0.807
• maximum for post-traumatic lesion score: 8.8
• maximum for neurological intervention: 6.1
• maximum for unfavorable outcome: 7.4
|
Score
|
Best Cut-Off
|
|
post-traumatic lesion
|
2.25 to 2.46
|
|
neurological intervention
|
1.81 to 2.40
|
|
unfavorable outcome
|
3.43 to 3.55
|
from page 414
|
Score
|
Sensitivity at Cut-Off
|
Specificity at Cut-Off
|
|
post-traumatic lesion
|
70%
|
94%
|
|
neurological intervention
|
82%
|
94%
|
|
unfavorable outcome
|
88%
|
95%
|
