A Prospective Evaluation of the Value of Repeat Cranial Computed Tomography in Patients With Minimal Head Injury and Intracranial Bleed: Sifri ZC, Homnick AT, Vaynman A, et al. J Trauma 2006;61:862–7

Abstract

This study from New Jersey is a prospective analysis of 161 consecutive patients over a 12-month period admitted to a trauma center with minimal head injury (MHI). MHI was defined as loss of consciousness or post-traumatic amnesia with a Glasgow Coma Scale (GCS) score ≥ 13 and an intracranial bleed (ICB) (including intra-cerebral hematoma or contusion, subdural, subarachnoid, and epidural hematoma) on initial cranial computed tomography (CT). The goal was to assess the value of repeat CT in these patients when they had no deterioration in their neurologic examination. Exclusion criteria were age < 18 years, history of prior brain surgery/pathology, chronic neurologic conditions (i.e., Parkinson or Alzheimer disease), spinal cord injury, history of coagulopathy, those who had immediate or planned neurosurgical intervention after their first CT scan, and those who never had a second CT scan. The remaining 130 patients underwent serial neurologic evaluation as well as repeat cranial CT scan within 24 hours. Ninety-nine (76%) patients had a normal neurologic examination at the time of their repeat cranial CT. None of these patients’ repeat CT scans prompted an immediate neurosurgical intervention (defined as craniotomy or placement of intracranial pressure monitor [ICP]) or change in management (defined as admission or transfer to intensive care unit or administration of medication to decrease intracranial pressure). None of these patients had a subsequent delayed neurological deterioration during the rest of their hospital stay. The authors conclude that significant financial and clinical benefits would come from eliminating unnecessary CT scans in patients with MHI who have a normal neurological examination. Limitations to this study include a small sample size from one institution, lack of blinded/standardized CT scan interpretation, and that follow-up was only until discharge from hospital, so it is unknown if any of the study patients had deterioration from their injury at a later date.