Repeat head computed tomography after minimal brain injury identifies the need for craniotomy in the absence of neurologic change

Thorson, Chad M.; Haren, Robert M. Van; Otero, Christian A.; Guarch, Gerardo A.; Curia, Emiliano; Barrera, Jose M.; Busko, Alexander M.; Namias, Nicholas; Bullock, M. Ross; Livingstone, Alan S.; Proctor, Kenneth G.

doi:10.1097/ta.0b013e3182877fed

Cited by 31 publications

(38 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Few studies have shown that routine repeat head CT is beneficial. 7,14,15,18 In a study by Park et al 7 in adult patients with GCS scores > 7, it was reported that 37% (n = 22) underwent surgical intervention due to radiological progression without neurological decline. The mean time between the initial and repeat head CT scan reported was 10.10 ± 7.25 hours.…”

Section: Discussionmentioning

confidence: 99%

“…The mean time between the initial and repeat head CT scan reported was 10.10 ± 7.25 hours. Thorson et al 15 reported that in patients requir- ing neurosurgical intervention, 32%-59% had no neurological decline before worsening of repeat CT. Based on their analysis, altered GCS score, Injury Severity Scale score, and the presence of mass effect were independently associated with worsening of repeat CT. In contrast, few studies have questioned the role of routine repeat CT in neurologically stable patients.…”

Section: Discussionmentioning

confidence: 99%

“…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. We also studied the factors associated with radiological progression that possibly predict the requirement of neurosurgical intervention.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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%

Section: Discussionmentioning

confidence: 99%

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

show abstract

“…In the studies with pediatric head trauma and serial CT, of the patients 9-16% showed epidural hemorrhage (EDH), 4.28-40% showed subdural hemorrhage (SDH), 1-57% showed intracranial hemorrhage (ICH), 6.04-64% showed subarachnoid hemorrhage (SAH), 8.5-38% showed contusion, 37.5% showed linear fracture, 7% showed depression fracture (10,20,21,22). Durham et al reported that repeated CT screening is suggested in children with high risk lesions with EDH, SDH, cerebral edema and ICH while this screening was emphasized to have limited advantages in patients with SAH, ICH and isolated head fractures unless there is deterioration in clinical situation of patients and the evaluation of risks in radiation exposure is necessary (23).…”

Section: Discussionmentioning

confidence: 99%

Travmatik Beyin Hasarlı Çocuk Hastalarda Tekrarlayan Bilgisayarlı Tomografinin Değerliliği ve Radyasyon Hasarı

Yazıcıoğlu

Özüçelik

Ayvaci

et al. 2014

HSP

View full text Add to dashboard Cite

25'i (%32,9) kız ve yaş ortalamaları 5,82 ± 3,66 bulundu. Araştırmaya alınan 76 hastaya toplamda 317 kez BT çekilmişti. Hastaların %42,10'una üç BT çekilirken geri kalanına üçten fazla BT çekilmişti. Hastaların %78,94'ünün sekelsiz taburcu olduğu, %7,9'unun opere edildiği görüldü. Hastaların ikinci BT'lerinde birinci BT'lerine göre sadece 2 hastada değişiklik saptandığı, yeni gelişen lezyon olarak bir hastada epidural hematom ve bir hastada subdural hematomun ortaya çıktığı belirlendi. Birinci BT sonuçlarına göre hastaların %7.9'una cerrahi tedavi uyulandı. Hastaların %92.1'i herhangi bir cerrahi tedavi uygulanmadan hastaneden taburcu oldu. Hastaların %6.6'sı sekelli iyileşirken, mortalite oranı %1.3 olarak bulundu. Tekrarlayan BT'ler ile çocuklara ek radyasyon dozu verilirken, tedavilerinde herhangi bir değişiklik oluşmadı. Sonuç: Kafa travmalı çocuklarda tekrarlayan BT'lerin hastanın prognozuna, acil cerrahi girişim ve tahmini yaşam beklentisine bir katkısı olmadığı tespit edilmiştir. Tekrarlayan BT çekimi uygulanan çocuklar, gelecekte radyasyon ile ilişkili gelişebilecek hastalıklar yönünden izlenmelidir. -diagnosis. Forty two point one percent of patients had CT three times, the rest had more than three times; total CT number was 317. Two patients showed changes in second CT (one epidural and one subdural hemorrhage) according to first CT whereas there was no change in third CT. The decision of operation in all operated patients treated surgically (7.9%) was given according to the result of first CT. While 92.1% of patients were discharged from the hospital by complete recovery, 6.6% of patients were with sequelae and mortality ratio was 1.3%. The changes in repeated CT did not change the treatment while every child was exposed to additional radiation. Conclusion: Repeated CT in children with head trauma did not contribute to the prognosis of patients, the choice of treatment and survival. The children applied serial CT should be followed for the diseases which can be progressed due to radiation in future.Key words: Head trauma in children, repeated brain CT, radiation exposure, traumatic brain injury Introduction Traumatic Brain Injury (TBI) is one of the most important diseases of 21. century which causes mortality and disablement (1,2). Different procedures about the indication, dosage of Head CT and repeated CT used common in pediatric TBI have been performed in different centers (3-4).The rates of CT used in the USA and other countries have increased rapidly particularly in the past 10 years (5). The use of CT procedures has expanded to more than 70 million in the United States per year, with nearly 10% of procedures performed on children (6).Although CT scans are very useful clinically, recent reports have raised concerns about the potential for malignancy following CT scanning, especially in pediatric patients (5) In a case-control study (part of the UK Childhood Cancer Study) by Rajaraman et al. was showed further evidence of possible excess risk of cancer, even at doses lower than those associated...

show abstract

“…Thorson and col leagues reported that repeat head CT after mTBI and positive first head CT revealed progression of injury in 30% of patients before clinical deterioration of neurologic symptoms helped in the early identif ication of patients requiring craniotomy. 74 An other study comprising 1019 consecutive TBI patients at a level I trauma center reported that worsening findings on the sched uled repeat head CT for patients with an abnormal first CT more likely result in neurosurgical intervention compared with a sta ble scheduled second head CT. 59 On the other hand, some investigators have reported that routine repeat head CT is not indicated for mTBI patients, even those whose initial head CT was positive for mTBI. Three factors independently predicted a worse repeat head CT: age 65 years or older, Glasgow Coma Scale score lower than 15, and multiple traumatic intracranial lesions noted on initial head CT. 75 Magnetic resonance imaging (MRI) is not commonly used in the acute management of TBIs; however, MRI has critical value in the diagnosis and management of injuries that cannot be suf ficiently evaluated by CT, such as diffuse axonal injuries.…”

Section: Use Of Imaging In the Manage Ment Of Traumatic Brain Injurymentioning

confidence: 99%

1 traumatic brain injury (TBI)Epidemiology of Traumatic Brain Injuries in the United States

Anzai¹,

Fink²

2015

Imaging of Traumatic Brain Injury

View full text Add to dashboard Cite

Repeat head computed tomography after minimal brain injury identifies the need for craniotomy in the absence of neurologic change

Abstract: Care management study, level III.

Cited by 31 publications

References 15 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

Travmatik Beyin Hasarlı Çocuk Hastalarda Tekrarlayan Bilgisayarlı Tomografinin Değerliliği ve Radyasyon Hasarı

1 traumatic brain injury (TBI)Epidemiology of Traumatic Brain Injuries in the United States

Contact Info

Product

Resources

About