Results of delayed follow-up imaging in traumatic brain injury

Abstract

OBJECT There is a paucity of scientific evidence available about the benefits of outpatient follow-up imaging for traumatic brain injury patients. In this study, 1 year of consecutive patients at a Level 1 trauma center were analyzed to determine if there is any benefit to routinely obtaining CT of the head at the outpatient follow-up visit. METHODS This single-institution retrospective review was performed on all patients with a traumatic brain injury seen at a Level 1 trauma center in 2013. Demographic data, types of injuries, surgical interventions, radiographic imaging in inpatient and outpatient settings, and outcomes were assessed through a review of the institution’s trauma registry, patient charts, and imaging. RESULTS Five hundred twenty-five patients were seen for traumatic brain injury in 2013 at Regional One Health in Memphis, Tennessee. One hundred eighty-five patients (35%) presented for outpatient follow-up, all with CT scans of the head. Seven of these patients (4%) showed worsening of their intracranial injuries on outpatient imaging studies; however, surgical intervention was recommended for only 3 of these patients (2%). All patients requiring an intervention had neurological deterioration prior to their follow-up appointment. CONCLUSIONS These experiences suggest that outpatient follow-up imaging for traumatic brain injury should be done selectively, as it was not helpful for patients who did not exhibit worsening of neurological signs or symptoms. Furthermore, routine outpatient imaging results in unnecessary resource utilization and radiation exposure.

Traumatic Brain Injury-related voiding dysfunction in mice is caused by damage to rostral pathways, altering inputs to the reflex pathways

“…Several studies using urodynamics on TBI patients have reported up to 85% of patients with bladder dysfunction 57,58 . Moreover, this dysfunction can persist longer term as reported by Khan et al (2016) where 34% of the group studied had combined bladder and bowel issues up to 5 years after a brain injury 59,60 . Bladder dysfunction that remains after rehabilitation contributes to a higher risk factor for a patient to be re-institutionalized 61 .…”

“…By contrast, TBI is relatively common and leads to clear cut brain degeneration. Models incorporating rmdTBI lead to brain degeneration which models human TBI as seen in collision sports or military trauma, with well characterized loss of cognitive and motor function and, in our studies, with loss of normal bladder function [6][7][8][9][10][11]20,54,[59][60][61] .…”