title: The value of scheduled repeat cranial computed tomography after mild head injury: single-center series and meta-analysis.
abstract: BACKGROUND
  After an initial computed tomography (CT) scan revealing intracranial hemorrhage resulting from traumatic brain injury, a standard of care in many trauma centers is to schedule a repeat CT scan to rule out possible progression of bleed.
  
  
  OBJECTIVE
  To evaluate the utility of routine follow-up CT in changing the management of mild head injury patients despite clinical stability, although repeat imaging is indicated to assess a deteriorating patient.
  
  
  METHODS
  The trauma database at our institution was retrospectively reviewed and the literature was searched to identify patients after mild head injury with positive initial CT finding and scheduled repeat scan. Patients were divided into 2 groups for comparison. Group A included patients who had intervention based on neurological examination changes. Group B comprised patients requiring a change in management according to CT results exclusively. The meta-analysis of the present cohort and included articles was performed with a random-effects model.
  
  
  RESULTS
  Overall, 15 studies and 445 patients met our eligibility criteria, totaling 2693 patients. Intervention rates of groups A and B were 2.7% (95% confidence interval, 1.7-3.9; P = .003) and 0.6% (95% confidence interval, 0.3-1; P = .21), respectively. The statistical difference between both intervention rates was clinically significant with P < .001.
  
  
  CONCLUSIONS
  The available evidence indicates that it is unnecessary to schedule a repeat CT scan after mild head injury when patients are unchanged or improving neurologically. In the absence of supporting data, we question the value of routine follow-up imaging given the associated accumulative increase in cost and risks.
authors.affiliation: Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada. Dr_menawer@hotmail.com
authors.forename: Saleh A
authors.initials: SA
authors.lastname: Almenawer
authors.forename: Iulia
authors.initials: I
authors.lastname: Bogza
authors.forename: Blake
authors.initials: B
authors.lastname: Yarascavitch
authors.forename: Niv
authors.initials: N
authors.lastname: Sne
authors.forename: Forough
authors.initials: F
authors.lastname: Farrokhyar
authors.forename: Naresh
authors.initials: N
authors.lastname: Murty
authors.forename: Kesava
authors.initials: K
authors.lastname: Reddy
mesh_terms: D001930:Brain Injuries / Q000000981:diagnostic imaging*; D019090:Case Management; D015331:Cohort Studies; D016001:Confidence Intervals; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D009460:Neurologic Examination; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging