Abstract
Computed tomography (CT) scan is a standard for the diagnosis of intracranial pathology after traumatic brain injury (TBI). Hemorrhagic progression of contusion (HPC) is frequently seen on repeat CT, but its clinical and radiological significance in case of mild TBI is not well define. The aim of the study: to evaluate the result of routine repeat head CT in patients with mild TBI and brain contusions. Materials and methods: retrospective analysis of management of patients with mild TBI (Glasgow Coma Scale (GCS) score – 13 to 15) and cerebral contusion. All patients were treated at the Kyiv City Clinical Emergency Hospital between 2016 and 2017. Results: within 202 patients with mild TBI, 87 (43.1 %) met the inclusion criteria and were selected for detailed analysis. There were 69 (79.3 %) men and 18 (20.7 %) women. The mean age of the patients was 43.8±12.7 years (17–82 years). The average time between trauma and CT was 3.3 hours. The average volume of contusion on the initial CT was 1.9±0.6 cm3 (0.2–9.6 cm3). The average time of routine CT was 6.8 hours (range 4–24 hours) after the initial scans. HPC was found in 24 (30.7 %) of 87 cases. The average volume of brain contusion on the repeat CT was 2.3±0.5 cm3 (0.2-17.1 cm3). In 3 (3.4 %) patients the size of the hematoma increased. Clinical deterioration occurred in 10 (11.5 %) patients. Six (6.9 %) patients were operated after a CT scan due to HPC with midline shift in 4 cases and increasing of subdural hematoma – 2 cases. Four of these patients had clinical deterioration, and 2 patients were neurological stable. Patients with HPC at admission had lower points of GCS, fractures of the skull (both p <0.001), subdural blood collection (p=0.002), a higher average duration of treatment 8.1±4.2 vs 14.3±5.2 days (p=0.0001), and mortality rate 0 vs. 3 (12.5 %) (p=0.02). Conclusions: Routine repeat CT in patients with mild TBI with brain contusions is aimed to find a patients with s high risk for clinical deterioration. One third of patients with mild TBI and brain contusion experienced HPC. Patients with HPC often have unfavorable clinical course with higher average duration of treatment, delay surgical treatment and mortality rate.
Highlights
A significant improvement in survival rate from 1970 to 1990 among patients with severetraumatic brain injury (TBI) was the result of introduction of Computed tomography (CT) and intracranial pressure monitoring and strict guidelines of treatment [1]
We found 202 patients with mild TBI and brain contusion, who were hospitalized in neurosurgical units of the Kyiv City Clinical Hospital from March 2016 to September 2017
We evaluated the following parameters: 1. The appearance of Hemorrhagic progression of contusion (HPC), after contusion enlargement ≥30 % of the initial size, or the appearance of a new contusion removed from the site of the primary damage on the repeat CT [10]. (Fig. 1), presents of acute epi-subdural haematomas, that do not require evacuation, cranial or skull base fracture
Summary
TBI was the result of introduction of CT and intracranial pressure monitoring and strict guidelines of treatment [1]. Neuroimaging is one of the most important stage in the treatment of patients with TBI. Indications for primary head CT in patients with trauma are clearly defined, but routine repeat head CT in medically managed patients with head injury is still controversial [3]. Studies have shown that normal neurologic status eliminates the necessity for routine repeat CT scan [4, 5]. In a prospective single-center study, more that 2/3 of the patients with mild brain contusions had (2020), «EUREKA: Health Sciences» Number 3 unremarkable neurological examination during the repeat CT scan, and none of these patients had further neurological deterioration and did not require neurosurgical intervention [8]
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