The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .
BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion .
The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .
Clinical decision instruments for CT scan in minor head trauma.
Previous studies have presented conflicting results regarding the predictive value of various clinical symptoms and signs for performing computed tomography ( CT ) scan in minor head injury . Moreover , despite the presence in the literature of several similar publications regarding whether or not CT should be employed at the time of presentation of minor head injured patients , data regarding delayed CT are limited . The objective of this study was to determine whether high-risk criteria represent a significant indication for initial CT scan in patients with minor head trauma , and whether or not analysis using delayed CT scan is necessary in patients with high-risk criteria before being discharged . Patients presenting to the Emergency Department with minor head trauma between September 1 , 2003 and September 1 , 2004 were evaluated prospect ively . After being divided into two main groups , low- and high-risk , four separate sub-groups based on age were established . Initial spiral CT examination was done within 3 h of trauma on all patients in addition to a delayed control CT scan in those with high-risk criteria between 16 and 24 h after trauma . The difference between the high- and low-risk groups in terms of abnormal CT findings was statistically significant ( p < 0.0005 ) . Among high-risk patients there was a significant difference between patients with a Glasgow Coma Scale ( GCS ) score of 13 or 14 and those with a GCS score of 15 ( p < 0.0005 ) . The relationship between vomiting and abnormal CT scan was significant ( odds ratio 4.61 , 95 % confidence interval 2.20 - 9.64 , p = 0.0001 ) , and the relationship between abnormal CT scan and suspected skull fracture was also significant ( odds ratio 3.46 , 95 % confidence interval 1.52 - 7.91 , p = 0.0032 ) . No significant correlations between other high-risk criteria and abnormal CT scan were determined . The difference between initial and delayed CT scans  in patients with high-risk criteria was not significant ( p = 0.161 ) . Low-risk patients with a  GCS score of 15 may be discharged without initial CT scan being performed . Initial CT scan absolutely must be performed , however , on patients with GCS < or = 15 in the event of vomiting or suspected skull fracture , even if isolated . Even though the difference between initial and delayed CT scans in patients with high-risk criteria is not significant , it is our opinion that it is still prudent for delayed CT scan to be performed , particularly on patients whose GCS score does not rise to 15 , or decreases
The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .
BACKGROUND Currently , there is no evidence -based definition for concussion that is being uniformly applied in clinical and research setting s. OBJECTIVE To conduct a systematic review of the highest- quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion .
The goal was to establish an evidence -based foundation from which to derive , in future work , a definition , diagnostic criteria , and prognostic indicators for concussion .