Clinical significance of head CT scan in patients admitted to the emergency department with mild head trauma

Head computed tomography (CT) scan is the gold standard for early diagnosis of brain injuries in the Emergency Department (ED), but clinically important injuries after a mild head trauma (MHT) are rare. This study aims to evaluate the impact of head CTs on the management of patients presenting to the ED with MHT. In this prospective observational study, we enrolled adult patients admitted to the ED of a medium-size University Hospital for MHT. Patients were evaluated at the time of admission and then at 6-24-48-72 h (if still in the ED). A 90-day telephone follow-up was performed. The primary composite endpoint was a change in patients' management (hospitalization, modifications in pharmacotherapy or invasive treatments) following a CT. Between June 2021 and July 2023 we enrolled 508 patients. At least 1 CT was performed in 454 patients (89.4%), and the first CT revealed a brain injury in 87 (19.2%) of them. At least another CT was repeated in the first 24 h in 144 patients; delayed injuries were observed in 4 cases only, with no clinical impact. The cumulative number of CTs performed throughout the study was 620, but only 24 of them (3.9%) had a clinical impact, and none of the patients underwent neurosurgery. The incidence of intracranial injuries requiring admission or treatments was 4.5%. In conclusion, the incidence of brain injuries requiring treatment was very low, and most of the CTs had no clinical impact.