The urgent postoperative CT scan: a critical appraisal of its impact.
Urgent CT scanning of critically ill neurosurgical patients is costly, labour intensive and associated with some risk. A study of urgent postoperative CT scans was carried out to assess the proportion that changed patient management. A further study evaluated the accuracy of predicting a haematoma. A retrospective analysis was carried out over a 6-month period of all scans performed within 48 h of craniotomy. This was followed by a prospective comparison between the surgeon's estimate of the chance of a haematoma on the scan and the scan result. Of 184 patient undergoing craniotomy, 40 patients (22%) were scanned within 48 h. Five patients were re-operated for haematoma formation. Prospective assessment showed that surgeons consistently over-estimated the risk at haematoma (mean prescan estimate 63%, actual risk 8%, p = 2.5 x 10(-12)). Less than 1 in 10 postoperative scans show a neurosurgical target. Other changes in management following scanning were slight.
Hussain
S A
SA
Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
Selway
R
R
Harding
C
C
Polkey
C E
CE
D003365:Costs and Cost Analysis; D003399:Craniotomy; D004638:Emergency Treatment / Q000191:economics / Q000706:statistics & numerical data*; D006406:Hematoma / Q000000981:diagnostic imaging*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012189:Retrospective Studies; D012306:Risk; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data*