Utility of routine follow-up head CT scanning after mild traumatic brain injury: a systematic review of the literature.
OBJECTIVE
To evaluate the efficacy of routine follow-up CT scans of the head after complicated mild traumatic brain injury (TBI).


METHODS
74 English language studies published from 1999 to February 2011 were reviewed. The papers were found by searching the PubMed database using a combination of keywords according to Cochrane guidelines. Excluding studies with missing or inappropriate data, 1630 patients in 19 studies met the inclusion criteria: complicated mild TBI, defined as a GCS score 13-15 with abnormal initial CT findings and the presence of follow-up CT scans. For these studies, the progression and type of intracranial haemorrhage, time from trauma to first scan, time between first and second scans, whether second scans were obtained routinely or for neurological decline and the number of patients who had a neurosurgical intervention were recorded.


RESULTS
Routine follow-up CT scans showed hemorrhagic progression in 324 patients (19.9%). Routine follow-up head CT scans did not predict the need for neurosurgical intervention (p=0.10) but a CT scan of the head performed for decline in status did (p=0.00046). For the 56 patients (3.4%) who declined neurologically, findings on the second CT scan were worse in 38 subjects (67%) and unchanged in the rest. Overall, 39 patients (2.4%) underwent neurosurgical intervention.


CONCLUSIONS
Routine follow-up CT scans rarely alter treatment for patients with complicated mild TBI. Follow-up CT scans based on neurological decline alter treatment five times more often than routine follow-up CT scans.
Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico 87131-0001, USA. mstippler@salud.unm.edu
Martina
M
Stippler
Carl
C
Smith
A Robb
AR
McLean
Andrew
A
Carlson
Sarah
S
Morley
Cristina
C
Murray-Krezan
Jessica
J
Kraynik
George
G
Kennedy
D020201:Brain Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000628:therapy; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D003955:Diagnostic Tests, Routine; D004636:Emergency Service, Hospital; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D017063:Outcome Assessment, Health Care; D014057:Tomography, X-Ray Computed