Is Routine Brain CT Scan, Performed for Early Follow Up in Head Trauma Patients with GCS 14-15, Always Justified?

Kessel Boris Itamar Ashkenazi

doi:10.4172/2167-1222.1000174

Abstract

Hypothesis : Routine repeat head Computed Tomography (CT) for patients with traumatic head injury, initially presenting with GCS of 14-15, does not change therapeutic policy in these trauma patients. Methods : This was a retrospective cohort study of trauma patients with Glasgow Coma Scale (GCS) of 14-15 on admission, suffering from different types of intracranial bleeding who were admitted for observation in a level II trauma center. The size of hematoma on initial head CT was measured and compared to findings of repeat CT performed following 12 hours. Patients were evaluated as to changes in neurologic status and treatment. Results: 68 patients treated over a period of 5 years were evaluated. Forty two (61.8%) were male and 24 (38.2%) were female. Mean age was 56.2 years and mean ISS score was 12 ± 5.1. Initial GCS was 15 in 51 patients and 14 in 15 other patients. CT scan revealed 7 epidural hematomas, 20 subdural hematomas, twenty eight intraparenchymal bleeding, and 13 subarchnoid hemorrhages. Repeat CT revealed an increase in size of the hematoma in 8 eight patients. None of these patients suffered from clinical deterioration. Repeat CT in 12 patients who’s GCS deteriorated, did not show any significant changes on the repeat CT scan. None of the patients underwent intervention after a routine repeat CT. Conclusions: Routine repeat CT scan of head, performed 12 hours after the initial scan did not change the therapeutic policy in GCS 14-15 head trauma patients. The need for mandatory CT of head in mild traumatic brain injury should be questioned

Highlights

Mild Traumatic Brain Injury (TBI) is common, with an estimated incidence between 100-300 cases per 100,000 people in the Western world [1]
When patients presenting with MHI have an Intracranial Hemorrhage (ICH) detected by initial head Computed Tomography (CT), a standard of care in many institutions is to obtain a second follow-up CT scan within 24 hours in order to define the need for neurosurgical intervention or patient transfer to a neurosurgical unit
In only one patient did the dimensions of the contusion increase on repeat CT (RCT), with 8 patients showing slight reduction in their follow-up Glasgow Coma Scale (GCS). (Table 1)

Summary

Introduction

Mild Traumatic Brain Injury (TBI) is common, with an estimated incidence between 100-300 cases per 100,000 people in the Western world [1]. When patients presenting with MHI have an Intracranial Hemorrhage (ICH) detected by initial head CT, a standard of care in many institutions is to obtain a second follow-up CT scan within 24 hours (a repeat CT-RCT) in order to define the need for neurosurgical intervention or patient transfer to a neurosurgical unit. These decisions have hitherto largely been made independently of the patient's clinical neurological status. Assessment of the clinical value of this protocol will assist in the timely transfer of high risk cases and will better direct the discharge of TBI patients as well as reduce hospital costs and diminish unwarranted radiation exposure [6,7,8]

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