Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury

Carlos V R Brown, Gabriel Zada, Ali Salim, Kenji Inaba, Georgios Kasotakis, Pantelis Hadjizacharia, Demetrios Demetriades, Peter Rhee

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

BACKGROUND: Controversy exists as to the role of a routine repeat head computed tomography (CT) for patients with traumatic brain injury and an initially abnormal head CT. The specific aim of this study is to identify patients with head injuries who would benefit from a routine repeat head CT. METHODS: This was a 2-year (2003 and 2004) prospective study of all patients with blunt trauma admitted to an urban, Level I trauma center that presented with an abnormal head CT. Results of initial head CT and indications for repeat head CT (routine vs. neurologic change) were recorded. Interventions were both medical (diuresis, hyperventilation, barbiturates) and surgical (intracranial pressure monitor placement or craniotomy). Patients were categorized by Glasgow Coma Scale (GCS) score as having mild (GCS 13-15), moderate (GCS 9-12), or severe (GCS ≤ 8) head injury. RESULTS: There were 354 patients admitted with an initially abnormal head CT. The 37 (10%) patients who went directly to craniotomy and the 43 (12%) patients who died within 24 hours of admission were excluded from analysis. The remaining 274 patients (44 years old, 70% male, mean injury severity score = 19, mean GCS = 10) are the focus of this analysis. After admission, 163 patients underwent a total of 241 repeat CT scans. Of the repeat scans obtained, 102 scans (43%) were unchanged, 54 scans (22%) were better, and 85 scans (35%) were worse. Neurologic deterioration prompted 45 repeat scans (19%), and 196 repeat scans (81%) were obtained routinely after admission without change in neurologic status. The 45 CT scans obtained for neurologic change led to medical or surgical intervention in 38% (n = 17) of cases, whereas scans obtained led to an intervention in only two patients (1%). Both patients who underwent an intervention after a routine scan had a GCS score ≤8 at admission and at the time of routine repeat head CT. One patient had an intracranial pressure monitor placed and the other was taken for craniotomy. No patient with a mild or moderate traumatic brain injury underwent an intervention after a routine repeat head CT. CONCLUSIONS: Patients with any head injury (mild, moderate, or severe) should undergo a repeat head CT after neurologic deterioration, because it leads to intervention in over one-third of patients. Routine repeat head CT is indicated for patients with a GCS score ≤8, as results might lead to intervention without neurologic change.

Original languageEnglish (US)
Pages (from-to)1339-1344
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume62
Issue number6
DOIs
StatePublished - Jun 2007

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Head
Tomography
Glasgow Coma Scale
Nervous System
Craniotomy
Craniocerebral Trauma
Traumatic Brain Injury
Intracranial Pressure
Barbiturates
Injury Severity Score
Hyperventilation
Trauma Centers
Diuresis
Prospective Studies

Keywords

  • Blunt
  • Computed tomography
  • Head injury
  • Trauma
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery

Cite this

Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury. / Brown, Carlos V R; Zada, Gabriel; Salim, Ali; Inaba, Kenji; Kasotakis, Georgios; Hadjizacharia, Pantelis; Demetriades, Demetrios; Rhee, Peter.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 62, No. 6, 06.2007, p. 1339-1344.

Research output: Contribution to journalArticle

Brown, CVR, Zada, G, Salim, A, Inaba, K, Kasotakis, G, Hadjizacharia, P, Demetriades, D & Rhee, P 2007, 'Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury', Journal of Trauma - Injury, Infection and Critical Care, vol. 62, no. 6, pp. 1339-1344. https://doi.org/10.1097/TA.0b013e318054e25a
Brown, Carlos V R ; Zada, Gabriel ; Salim, Ali ; Inaba, Kenji ; Kasotakis, Georgios ; Hadjizacharia, Pantelis ; Demetriades, Demetrios ; Rhee, Peter. / Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury. In: Journal of Trauma - Injury, Infection and Critical Care. 2007 ; Vol. 62, No. 6. pp. 1339-1344.
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abstract = "BACKGROUND: Controversy exists as to the role of a routine repeat head computed tomography (CT) for patients with traumatic brain injury and an initially abnormal head CT. The specific aim of this study is to identify patients with head injuries who would benefit from a routine repeat head CT. METHODS: This was a 2-year (2003 and 2004) prospective study of all patients with blunt trauma admitted to an urban, Level I trauma center that presented with an abnormal head CT. Results of initial head CT and indications for repeat head CT (routine vs. neurologic change) were recorded. Interventions were both medical (diuresis, hyperventilation, barbiturates) and surgical (intracranial pressure monitor placement or craniotomy). Patients were categorized by Glasgow Coma Scale (GCS) score as having mild (GCS 13-15), moderate (GCS 9-12), or severe (GCS ≤ 8) head injury. RESULTS: There were 354 patients admitted with an initially abnormal head CT. The 37 (10{\%}) patients who went directly to craniotomy and the 43 (12{\%}) patients who died within 24 hours of admission were excluded from analysis. The remaining 274 patients (44 years old, 70{\%} male, mean injury severity score = 19, mean GCS = 10) are the focus of this analysis. After admission, 163 patients underwent a total of 241 repeat CT scans. Of the repeat scans obtained, 102 scans (43{\%}) were unchanged, 54 scans (22{\%}) were better, and 85 scans (35{\%}) were worse. Neurologic deterioration prompted 45 repeat scans (19{\%}), and 196 repeat scans (81{\%}) were obtained routinely after admission without change in neurologic status. The 45 CT scans obtained for neurologic change led to medical or surgical intervention in 38{\%} (n = 17) of cases, whereas scans obtained led to an intervention in only two patients (1{\%}). Both patients who underwent an intervention after a routine scan had a GCS score ≤8 at admission and at the time of routine repeat head CT. One patient had an intracranial pressure monitor placed and the other was taken for craniotomy. No patient with a mild or moderate traumatic brain injury underwent an intervention after a routine repeat head CT. CONCLUSIONS: Patients with any head injury (mild, moderate, or severe) should undergo a repeat head CT after neurologic deterioration, because it leads to intervention in over one-third of patients. Routine repeat head CT is indicated for patients with a GCS score ≤8, as results might lead to intervention without neurologic change.",
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AU - Zada, Gabriel

AU - Salim, Ali

AU - Inaba, Kenji

AU - Kasotakis, Georgios

AU - Hadjizacharia, Pantelis

AU - Demetriades, Demetrios

AU - Rhee, Peter

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N2 - BACKGROUND: Controversy exists as to the role of a routine repeat head computed tomography (CT) for patients with traumatic brain injury and an initially abnormal head CT. The specific aim of this study is to identify patients with head injuries who would benefit from a routine repeat head CT. METHODS: This was a 2-year (2003 and 2004) prospective study of all patients with blunt trauma admitted to an urban, Level I trauma center that presented with an abnormal head CT. Results of initial head CT and indications for repeat head CT (routine vs. neurologic change) were recorded. Interventions were both medical (diuresis, hyperventilation, barbiturates) and surgical (intracranial pressure monitor placement or craniotomy). Patients were categorized by Glasgow Coma Scale (GCS) score as having mild (GCS 13-15), moderate (GCS 9-12), or severe (GCS ≤ 8) head injury. RESULTS: There were 354 patients admitted with an initially abnormal head CT. The 37 (10%) patients who went directly to craniotomy and the 43 (12%) patients who died within 24 hours of admission were excluded from analysis. The remaining 274 patients (44 years old, 70% male, mean injury severity score = 19, mean GCS = 10) are the focus of this analysis. After admission, 163 patients underwent a total of 241 repeat CT scans. Of the repeat scans obtained, 102 scans (43%) were unchanged, 54 scans (22%) were better, and 85 scans (35%) were worse. Neurologic deterioration prompted 45 repeat scans (19%), and 196 repeat scans (81%) were obtained routinely after admission without change in neurologic status. The 45 CT scans obtained for neurologic change led to medical or surgical intervention in 38% (n = 17) of cases, whereas scans obtained led to an intervention in only two patients (1%). Both patients who underwent an intervention after a routine scan had a GCS score ≤8 at admission and at the time of routine repeat head CT. One patient had an intracranial pressure monitor placed and the other was taken for craniotomy. No patient with a mild or moderate traumatic brain injury underwent an intervention after a routine repeat head CT. CONCLUSIONS: Patients with any head injury (mild, moderate, or severe) should undergo a repeat head CT after neurologic deterioration, because it leads to intervention in over one-third of patients. Routine repeat head CT is indicated for patients with a GCS score ≤8, as results might lead to intervention without neurologic change.

AB - BACKGROUND: Controversy exists as to the role of a routine repeat head computed tomography (CT) for patients with traumatic brain injury and an initially abnormal head CT. The specific aim of this study is to identify patients with head injuries who would benefit from a routine repeat head CT. METHODS: This was a 2-year (2003 and 2004) prospective study of all patients with blunt trauma admitted to an urban, Level I trauma center that presented with an abnormal head CT. Results of initial head CT and indications for repeat head CT (routine vs. neurologic change) were recorded. Interventions were both medical (diuresis, hyperventilation, barbiturates) and surgical (intracranial pressure monitor placement or craniotomy). Patients were categorized by Glasgow Coma Scale (GCS) score as having mild (GCS 13-15), moderate (GCS 9-12), or severe (GCS ≤ 8) head injury. RESULTS: There were 354 patients admitted with an initially abnormal head CT. The 37 (10%) patients who went directly to craniotomy and the 43 (12%) patients who died within 24 hours of admission were excluded from analysis. The remaining 274 patients (44 years old, 70% male, mean injury severity score = 19, mean GCS = 10) are the focus of this analysis. After admission, 163 patients underwent a total of 241 repeat CT scans. Of the repeat scans obtained, 102 scans (43%) were unchanged, 54 scans (22%) were better, and 85 scans (35%) were worse. Neurologic deterioration prompted 45 repeat scans (19%), and 196 repeat scans (81%) were obtained routinely after admission without change in neurologic status. The 45 CT scans obtained for neurologic change led to medical or surgical intervention in 38% (n = 17) of cases, whereas scans obtained led to an intervention in only two patients (1%). Both patients who underwent an intervention after a routine scan had a GCS score ≤8 at admission and at the time of routine repeat head CT. One patient had an intracranial pressure monitor placed and the other was taken for craniotomy. No patient with a mild or moderate traumatic brain injury underwent an intervention after a routine repeat head CT. CONCLUSIONS: Patients with any head injury (mild, moderate, or severe) should undergo a repeat head CT after neurologic deterioration, because it leads to intervention in over one-third of patients. Routine repeat head CT is indicated for patients with a GCS score ≤8, as results might lead to intervention without neurologic change.

KW - Blunt

KW - Computed tomography

KW - Head injury

KW - Trauma

KW - Traumatic brain injury

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