Does routine serial computed tomography of the head influence management of traumatic brain injury? A prospective evaluation.
BACKGROUND
Computed tomography (CT) of the head is the current standard for diagnosing intracranial pathology following blunt head trauma. It is common practice to repeat the head CT to evaluate any progression of injury. Recent retrospective reviews have challenged the need for serial head CT after traumatic brain injury (TBI). This study intends to prospectively examine the value of routine serial head CT after TBI.


METHODS
Consecutive adult blunt trauma patients with an abnormal head CT admitted to an urban, Level I trauma center from January 2003 to September 2003 were prospectively studied. Variables collected included: initial head CT results, indication for repeat head CT (routine versus neurologic change), number and results of repeat head CT scans, and clinical interventions following repeat head CT.


RESULTS
Over the 9-month period, there were 128 patients admitted with an abnormal head CT after sustaining blunt trauma. The 16 patients who died within 24 hours and the 12 patients who went directly to craniotomy were excluded. The remaining 100 patients make up the study population. Abnormal head CT findings were subarachnoid hemorrhage (47%), intraparenchymal hemorrhage (37%), subdural hematoma (28%), contusion (14%), epidural hematoma (11%), intraventricular hemorrhage (3%), and diffuse axonal injury (2%). Overall, 32 patients (32%) had only the admission head CT, while 68 patients (68%) underwent 90 repeat CT scans. Of the repeat head CT scans, 81 (90%) were performed on a routine basis without neurologic change. The remaining 9 (10%) were performed for a change in Glasgow Coma Scale (n = 5), change in intracranial pressure (n = 1), change in Glasgow Coma Scale and intracranial pressure (n = 1), change in pupil size (n = 1), or sudden appearance of a headache (n = 1). Three patients had their care altered after repeat head CT: two underwent craniotomy and one was started on barbiturate therapy. All three patients had their repeat head CT after neurologic change (decrease in Glasgow Coma Scale in 2 and increase in intracranial pressure in 1).


CONCLUSIONS
Serial head CT is common after TBI. Most repeat head CT scans are performed on a routine basis without neurologic change. Few patients with TBI have their management altered after repeat head CT, and these patients have neurologic deterioration before the repeat head CT. The use of routine serial head CT in patients without neurologic deterioration is not supported by the findings of this study.
Brown
Carlos V R
CV
Department of Surgery, Division of Trauma and Critical Care, Los Angeles County and University of Southern California Medical Center, Los Angeles, California, USA. carlosbr@usc.edu
Weng
Janie
J
Oh
Daniel
D
Salim
Ali
A
Kasotakis
Georgios
G
Demetriades
Demetrios
D
Velmahos
George C
GC
Rhee
Peter
P
D000328:Adult; D020201:Brain Hemorrhage, Traumatic / Q000000981:diagnostic imaging* / Q000628:therapy; D003955:Diagnostic Tests, Routine; D005260:Female; D015600:Glasgow Coma Scale; D006257:Head / Q000000981:diagnostic imaging; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging* / Q000628:therapy; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014193:Trauma Centers