Is repeat head CT necessary in patients with mild traumatic intracranial hemorrhage

Ornam, Jonathan Van; Pruitt, Peter B.; Borczuk, Pierre

doi:10.1016/j.ajem.2018.12.012

Cited by 17 publications

(12 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In contrast, few studies have questioned the role of routine repeat CT in neurologically stable patients. 1,4,9,13,16,17 In a study by Van Ornam et al 16 in patients with traumatic intracranial hemorrhage and GCS scores > 12, only 3 patients underwent neurosurgical intervention due to worsening of repeat CT without neurological decline. The number of repeat scans required to identify one patient was 305.…”

Section: Discussionmentioning

confidence: 99%

“…clinical deterioration, which would lead to neurosurgical intervention. Some studies have shown that a routine repeat head CT scan is not indicated unless there is a neurological deterioration, 1,2,16,17 while others suggest routine repeat imaging is necessary to identify the subset of patients without neurological deterioration who require neurosurgical intervention. 7,14,15 The aim of this study was to evaluate the role of repeat CT imaging in patients with mild to moderate head injury who were initially treated medically.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Role of repeat CT in mild to moderate head injury: an institutional study

Nagesh¹,

Patel²,

Mishra³

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEPatients with traumatic brain injury (TBI) often undergo repeat head CT scans to identify the possible progression of injury. The objective of this study is to evaluate the need for routine repeat head CT scans in patients with mild to moderate head injury and an initial positive abnormal CT scan.METHODSThis is a retrospective study of patients presenting to the emergency department from January 2016 to December 2017 with Glasgow Coma Scale (GCS) scores > 8 and an initial abnormal CT scan, who underwent repeat CT during their in-hospital medical management. Patients who underwent surgery after the first CT scan, had a GCS score < 9, or had a normal initial CT scan were excluded. Demographic, medical history, and physical examination details were collected, and CT scans were reviewed. Radiological deterioration, neurological deterioration, and/or the need for neurosurgical intervention were the primary outcome variables.RESULTSA total of 1033 patients were included in this study. These patients underwent at least two CT scans on an inpatient basis. Of these 1033 patients, 54.1% had mild head injury and 45.9% had moderate head injury based on GCS score at admission. The most common diagnosis was contusion (43.8%), followed by extradural hematoma (28.8%) and subdural hematoma (26.6%). A total of 2636 CT scans were performed for 1033 patients, with a mean of 2.55 per patient. Of these, 25 (2.4%) had neurological deterioration, 90 (8.7%) had a progression of an existing lesion or appearance of a new lesion on repeat CT, and 101 (9.8%) required neurosurgical intervention. Seventy-five patients underwent surgery due to worsening of repeat CT without neurological deterioration, so the average number of repeat CT scans required to identify one such patient was 21.3. On multiple logistic regression, GCS score at admission (p = 0.024), abnormal international normalized ratio (INR; p < 0.001), midline shift (p = 0.005), effaced basal cisterns (p < 0.001), and multiple hemorrhagic lesions (p = 0.010) were associated with worsening of repeat CT, neurological deterioration, and/or need for neurosurgical intervention.CONCLUSIONSThe role of routine repeat head CT in medically managed patients with head injury is controversial. The authors have tried to study the various factors that are associated with neurological deterioration, radiological deterioration, and/or need for neurosurgical intervention. In this study the authors found lower GCS score at admission, abnormal INR, presence of midline shift, effaced basal cisterns, and multiple lesions on initial CT to be significantly associated with the above outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Role of repeat CT in mild to moderate head injury: an institutional study

Nagesh¹,

Patel²,

Mishra³

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…5 The reported risk of delayed ICH after head injury has varied in the literature from 0% to 4%. [10][11][12][13][14][15][16] Several clinical guidelines highlight the risk of traumatic delayed ICH in patients taking antiplatelet agents. [17][18][19] According to the 2014 National Institute of Health and Care Excellence guidelines on head injury, for patients on aspirin or clopidogrel, 'the reference standard should include CT head scan and a follow-up period of sufficient duration to capture delayed bleeding, for example, at 7 days and 1 month'.…”

Section: Introductionmentioning

confidence: 99%

Antiplatelet therapy is associated with a high rate of intracranial hemorrhage in patients with head injuries

Alter

Mazer

Solano

et al. 2020

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

BackgroundAntiplatelet agents are increasingly used in cardiovascular treatment. Limited research has been performed into risks of acute and delayed traumatic intracranial hemorrhage (ICH) in these patients who sustain head injuries. Our goal was to assess the overall odds and identify factors associated with ICH in patients on antiplatelet therapy.MethodsA retrospective observational study was conducted at two level I trauma centers. Adult patients with head injuries on antiplatelet agents were enrolled from the hospitals’ trauma registries. Acute ICH was diagnosed by head CT. Observation and repeat CT to evaluate for delayed ICH was performed at clinicians’ discretion. Patients were stratified by antiplatelet type and analyzed by ICH outcome.ResultsOf 327 patients on antiplatelets who presented with blunt head trauma, 133 (40.7%) had acute ICH. Three (0.9%) had delayed ICH on repeat CT, were asymptomatic and did not require neurosurgical intervention. One with delayed ICH was on clopidogrel and two were on both clopidogrel and aspirin. Patients with delayed ICH compared with no ICH were older (94 vs 74 years) with higher injury severity scores (15.7 vs 4.4) and trended towards lower platelet counts (141 vs 216). Patients on aspirin had a higher acute ICH rate compared with patients on P2Y12 inhibitors (48% vs 30%, 18% difference, 95% CI 4 to 33; OR 2.18, 95% CI 1.15 to 4.13). No other group comparison had significant differences in ICH rate.ConclusionsPatients on antiplatelet agents with head trauma have a high rate of ICH. Routine head CT is recommended. Patients infrequently developed delayed ICH. Routine repeat CT imaging does not appear to be necessary for all patients.Level of evidenceLevel III, prognostic.

show abstract

“…Patients with TICH frequently undergo neurologic deterioration due to an expanding hematoma. Even with surgical intervention, such patients experienced poor long-term outcomes ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Application of Absolute Alcohol in the Treatment of Traumatic Intracranial Hemorrhage via Interventional Embolization of Middle Meningeal Artery

et al. 2020

View full text Add to dashboard Cite

Background: Traumatic brain injury is a common condition in neurosurgery. Traditional methods of treatment include conservative treatment and surgical evacuation using burr-holes or craniotomy; however, studies have reported problems such as high re-expansion rates after conservative treatment of epidural hematoma and high postoperative recurrence rates of subdural hematoma. Solutions to these problems are lacking, and research into new treatment methods is ongoing. Among the potential new treatments, middle meningeal arterial embolization is an option. This study involved patients with acute epidural hematoma and chronic subdural hematoma. The purpose was to evaluate the use and effects of absolute alcohol to embolize the middle meningeal artery to treat intracranial hematoma. Material and Methods: A retrospective description study was 12 cases of intracranial hematoma who treated with absolute alcohol interventional therapy from our hospital between June 2018 and October 2019. Five patients with acute epidural hematoma and seven patients with chronic subdural hematoma were treated using absolute alcohol to embolize the middle meningeal artery. Patients' clinical data, imaging results, surgical results, and prognosis were recorded and analyzed. Results: All patients underwent absolute alcohol embolization of the middle meningeal artery, in combination with burr-hole drainage. All imaging data were confirmed preoperatively. We successfully used absolute alcohol to embolize the middle meningeal artery intraoperatively and confirmed these results by postoperative angiography. All patients achieved symptomatic relief without complications, and no recurrence or re-expansion was seen with follow-up computed tomography. Our study has been registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn , ChiCTR1800018714). Conclusion: The use of absolute alcohol to embolize the middle meningeal artery could be used as an attempt to treat acute epidural hematoma and chronic subdural hematoma.

show abstract

Is repeat head CT necessary in patients with mild traumatic intracranial hemorrhage

Cited by 17 publications

References 19 publications

Role of repeat CT in mild to moderate head injury: an institutional study

Role of repeat CT in mild to moderate head injury: an institutional study

Antiplatelet therapy is associated with a high rate of intracranial hemorrhage in patients with head injuries

Application of Absolute Alcohol in the Treatment of Traumatic Intracranial Hemorrhage via Interventional Embolization of Middle Meningeal Artery

Contact Info

Product

Resources

About