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Intracranial Pathology (CT+) in Emergency Department Patients With High GCS and High Standard Assessment of Concussion (SAC) Scores

Curley, Kenneth, C., MD; O'Neil, Brian, J., MD; Naunheim, Rosanne, MD; Wright, David, W., MD

Journal of Head Trauma Rehabilitation: May/June 2018 - Volume 33 - Issue 3 - p E61–E66
doi: 10.1097/HTR.0000000000000355
Focus on Clinical Research and Practice

Objective: To demonstrate that a subpopulation of patients with mild/moderate traumatic brain injury (TBI) had intracranial pathology despite having a Glasgow Coma Scale (GCS) score of 15 and a Standardized Assessment of Concussion (SAC) score of 25 or higher.

Setting: A network of 11 US emergency departments (ED) enrolling patients in a multisite study of TBI.

Participants: Men and women between the ages of 18 and 85 years admitted to a participating ED having sustained a closed head injury within the prior 72 hours and a GCS score of 13 to 15 at the time of enrollment.

Design: Prospective observational study.

Main Measures: GCS, SAC, computed tomography (CT) positive or negative for intracranial pathology, Marshall scoring of CT scans.

Results: Of 191 patients with intracranial pathology (CT+) and having a SAC score recorded, 24% (46/191) had a SAC score in the normal range (≥25) as well as a GCS score of 15. All causes of CT+ brain injury were present in both SAC groups.

Conclusion: A normal GCS score and a SAC score do not exclude the possibility of significant intracranial injury.

Iatrikos Research and Development Strategies, LLC, Tampa, Florida (Dr Curley); Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Curley); Department of Emergency Medicine, School of Medicine, Wayne State University, Detroit, Michigan (Dr O'Neil); Department of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri (Dr Naunheim); and Department of Emergency Medicine, Emory University School of Medicine, and Grady Memorial Hospital, Atlanta, Georgia (Dr Wright).

Corresponding Author: Kenneth C. Curley, MD, Iatrikos Research and Development Strategies, 1301 S. Howard Ave, Unit C-5, Tampa, FL 33606 (

This study was funded in part by a research contract from the US Army, contract #W81XWH-14-C-1405. Data acquisition for this study was supported by research grants from BrainScope Co, Inc, to the clinical sites. The authors acknowledge the contributions of the research staff at the clinical sites for their efforts toward conducting of this study and the patients who volunteered to participate. The study was a cohort extracted from a parent study funded in part by research contract #W81XWH-14-C-1405, titled, “Validation of Point-of-Care TBI Detection System for Head-Injured Patients.”

The views, opinions and/or findings contained in this report are those of the author(s) and should not be construed as an official Department of the Army or US government position, policy, or decision unless so designated by other documentation. In the conduct of research where humans are the subjects, the investigator(s) adhered to the policies regarding the protection of human subjects as prescribed by Code of Federal Regulations (CFR) Title 45, Volume 1, Part 46; Title 32, Chapter 1, Part 219; and Title 21, Chapter 1, Part 50 (Protection of Human Subjects).

Drs O'Neil, Naunheim, and Wright were principal investigators at clinical data acquisition sites. Dr Curley was a consultant to BrainScope Co, Inc, between March and August 2016, and who at the time the study was conducted was the Neurotrauma Research Portfolio Manager for Combat Casualty Care Research Program and Defense Health Program at the US Army Medical Research and Materiel Command.

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