Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: We performed additional analyses to answer Dr Schwam's question about the sensitivity and specificity of the CCHR for clinically important lesions in patients with a GCS score of 15, no focal neurological deficit, and no anticoagulation. In our study population, 2104 of the patients fulfilled these criteria, 1473 of whom had a history of loss of consciousness or posttraumatic amnesia. Of these patients, 87 (5.9%) had 1 or more clinically important lesions on CT scan: hemorrhagic contusion (n = 36 [41%]), traumatic subarachnoid hemorrhage (n = 29 [33%]), subdural hematoma (n = 18 [21%]), epidural hematoma (n = 12 [14%]), nonhemorrhagic contusion (n = 7 [8%]), diffuse axonal injury (n = 7 [8%]), depressed skull fracture (n = 3 [3%]), intraventricular hemorrhage (n = 3 [3%]), and subdural effusion (n = 1 [1%]). Additionally, skull base fractures in 17 patients (20%) and linear fractures in 23 patients (26%) were observed in combination with other lesions.
Smits M, Dippel DWJ, Hunink MGM. CT Scanning for Minor Head Injury—Reply. JAMA. 2006;295(5):497-498. doi:10.1001/jama.295.5.497-b