Routinely repeated computed tomography after blunt head trauma: does it benefit patients?
BACKGROUND
Computed tomography of the head (HCT) is an integral part of the diagnosis and management of the patient with head injury, but the utility of repeated HCT performed solely for routine follow-up in the patient with blunt head trauma has not been defined. In the absence of clinical indications, routinely repeated HCT, even in patients with significant brain injury, does not contribute to patient care.


METHODS
Trauma registry records at a Level I trauma center from July 1, 1997, to June 30, 2002, were reviewed. Patients with severe blunt head injury (Abbreviated Injury Scale score > or = 3) admitted to the intensive care unit and who had a repeat HCT scan obtained for scheduled follow-up were included. Those patients with initial craniotomy, repeat HCT more than 72 hours after the initial HCT, or repeat HCT ordered for clinical indications were excluded. Data included were age, mechanism of injury, time to initial (HCT1) and repeat HCT (HCT2), indications for HCT2, and HCT findings. Additional data included Glasgow Coma Scale (GCS) score (admission and at HCT2); Injury Severity Score; occurrence of hypotension, coagulopathy, or elevated intracranial pressure (ICP); interventions made; and patient outcome.


RESULTS
Entry criteria were met in 462 patients. Most were injured in motor vehicle crashes; the average age was 36 years and the mean initial GCS score was 9. The mean time to HCT1 was 1.3 hours and the mean time to HCT2 was 22.6 hours. HCT2 showed worsening in 85 patients (18.4%), and 16 patients had interventions in response to HCT2 (repeat HCT in 8, ICP monitoring or drainage in 6, and craniotomy in 2). No patient undergoing routine repeat HCT without other clinical findings required intervention. All patients with worsening HCT findings requiring intervention had coagulopathy, hypotension, ICP elevation, or marked decrease in GCS score.


CONCLUSIONS
In the absence of clinical indicators or risk factors, repeat HCT after blunt head injury does not alter patient management and is unnecessary.
Kaups
Krista L
KL
Department of Surgery, 4th Floor, University Medical Center, 445 South Cedar Avenue, Fresno, CA 93702, USA. kaups@ucsfresno.edu
Davis
James W
JW
Parks
Steven N
SN
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D002140:California; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003399:Craniotomy; D003422:Critical Care / Q000706:statistics & numerical data; D019091:Critical Pathways; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011379:Prognosis; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014696:Ventriculostomy