Abstract
Introduction
A rule exists regarding the use of computed tomography (CT) for patients presenting to the emergency department with head trauma and a Glasgow coma score (GCS) of 15; however, it can be difficult to make this decision due to overcrowded emergency rooms or exaggerated patients complaints. We evaluated patients who presented to the emergency room with minor head trauma, and we aimed to investigate the relationship between brain pathology on CT and hematological markers in order to find markers that help us identify brain pathology in patients with a GCS of 15.
Methods
This retrospective study included 100 patients with pathologies present on their CT scans and a control group consisting of 100 patients with a normal CT. All data obtained from this study were recorded and evaluated using “Statistical Package for Social Sciences for Windows 20” program. Parametric tests (independent samples test) were used with normally distributed data, while non-parametric tests (Mann–Whitney U test) were used with non-normally distributed data. A p ≤ 0.05 was considered significant.
Finding
When we divided the cases into two groups based on the presence of pathologies on CT scan, we determined that there were significant differences between the groups in terms of white blood cell (WBC), hemoglobin (Hb), mean platelet volume (MPV), neutrophil (neu), troponin T, neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). When differentiating the patients that had brain pathologies on CT scan from patients that had normal CT scans, the troponin T cut-off value of 6.16 lead to 90 % specificity, and setting the NLR cut-off value at 4.29 resulted in a specificity of 90 %.
Conclusion
MPV, NLR, and troponin T can be used as parameters that indicate brain pathologies on CT scans of patients presenting to the emergency department with isolated minor head trauma and GCS of 15 when the necessity of a CT scan is otherwise unclear.
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References
Dalbayrak S, Gumustas S, Bal A, Akansel G. Early and delayed CT findings in patients with mild-to-moderate head trauma. Turk Neurosurg. 2011;21(4):591–8.
Gentry LR. Imaging of closed head injury. Radiology. 1994;1:1–17.
Boran BO, Barut N, Akgün C, Çelikoğlu E, Bozbuğa M. Indications for computed tomography in patients with mild head injuries. Ulus Travma Acil Cerrahi Derg. 2005;3:218–23.
Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, et al. The Canadian CT head rule for patients with minor head injury. Lancet. 2001;357:1391–6.
Kavalci C, Aksel G, Salt O, Yilmaz MS, Demir A, Kavalci G, et al. Comparison of the Canadian CT head rule and the New Orleans criteria in patients with minor head injury. World J Emerg Surg. 2014;9:31.
Jeret SJ, Menachem M, Anziska B, Lipitz M, Vilceus AP, Ware JA, et al. Clinical predictors of abnormality disclosed by computed tomography after mild head trauma. Neurosurgery. 1993;32:9–15 (discussion 15–6).
MacLaren RE, Ghoorahoo HI, Kirby NG. Use of an accident and emergency department observation ward in the management of head injury. Br J Surg. 1993;80:215–7.
Probst MA, Kanzaria HK, Schriger DL. A conceptual model of emergency physician decision making for head computed tomography in mild head injury. Am J Emerg Med. 2014;32:645–50.
Peng W, Li C, Wen TF, Yan LN, Li B, Wang WT, et al. Neutrophil to lymphocyte ratio changes predict small hepatocellular carcinoma survival. J Surg Res. 2014;192:402–8.
Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther. 2013;11:55–9.
Lippi G, Carbucicchio A, Benatti M, Cervellin G. The mean platelet volume is decreased in patients with mild head trauma and brain injury. Blood Coagul Fibrinolysis. 2013;24:780–3.
Templeton AJ, Pezero C, Omlin A, McNamara MG, Leibowitz-Amit R, Vera-Badillo FE, et al. Simple prognostic score for metastatic castration-resistant prostate cancer with incorporation of neutrophil-to-lymphocyte ratio. Cancer Month. 2014;120:3346–52.
Soylu K, Yuksel S, Gulel O, Erbay AR, Meric M, Zengin H, Museyibov M, et al. The relationship of coronary flow to neutrophil/lymphocyte ratio in patients undergoing primary percutaneous coronary intervention. J Thorac Dis. 2013;5:258–64.
Shen XH, Chen Q, Shi Y, Li HW. Association of neutrophil/lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Chin Med J (Engl). 2010;123:3438–43.
Wolf H, Frantal S, Pajenda GS, Salameh O, Widhalm H, Hajdu S, et al. Predictive value of neuromarkers supported by a set of clinical criteria in patients with mild traumatic brain injury: S100B protein and neuron-specific enolase on trial: clinical article. J Neurosurg. 2013;118:1298–303.
Kavalci C, Pekdemir M, Durukan P, Ilhan N, Yildiz M, Serhatlioglu S, et al. The value of serum tau protein for the diagnosis of intracranial injury in minor head trauma. Am J Emerg Med. 2007;25:391–5.
Hensler T, Sauerland S, Riess P, Hess S, Helling HJ, Andermahr J, et al. The effect of additional brain injury on systemic interleukin (IL)-10 and IL-13 levels in trauma patients. Inflamm Res. 2000;49:524–8.
Sheehan P, Vasikaran SD. The evolving clinical role of cardiac troponins and new acute myokardial infarction guidelines: implications for the clinical laboratory. Clin Bichemist Rev. 2001;23:52–65.
Hays A, Diringer MN. Elevated troponin levels are associated with higher mortality following intracerebral hemorrhage. Neurology. 2006;66:1330–4.
Salim A, Hadjizacharia P, Brown C, Inaba K, Teixeira PG, Chan L, et al. Significance of troponin elevation after severe traumatic brain injury. J Trauma. 2008;64:46–52.
Lippi G, Dipalo M, Carbucicchio A, Aloe R, Benatti M, Cervellin G. The concentration of highly-sensitive troponin I is increased in patients with brain injury after mild head trauma. Int J Cardiol. 2013;168:1617–8.
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Ethem Acar, Ahmet Demir, Ömer Dogan Alatas, Halil Beydilli, Birdal Yıldırım, Ulviye Kırlı, D. Burcu Hazer, M.Rabia Kılınç, Ülkü Karagöz and Serhan Derin declare that they have no conflict of interest.
Compliance with ethical requirements
The study was conducted in the Mugla Universty Training and Education Hospital in Turkey. Ethical clearance was obtained from the ethics committee of Mugla University (no:2014/12).
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Acar, E., Demir, A., Alatas, Ö.D. et al. Evaluation of hematological markers in minor head trauma in the emergency room. Eur J Trauma Emerg Surg 42, 611–616 (2016). https://doi.org/10.1007/s00068-015-0579-8
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DOI: https://doi.org/10.1007/s00068-015-0579-8