title: Bedside computed tomography in traumatic brain injury: Experience of 10,000 consecutive cases in neurosurgery at a level 1 trauma center in India.
abstract: BACKGROUND
  Patients with traumatic brain injury (TBI) need frequent computed tomography (CT) of the head for assessment and management. In view of the associated polytrauma, hemodynamic instability, and various in-dwelling catheters and tubes, shifting of patients for CT scans may be difficult.
  
  
  OBJECTIVE
  To assess the role of mobile CT (Ceretom®; NeuroLogica Corporation, Boston, MA, USA) in a trauma center with respect to patient management.
  
  
  METHODS
  In this retrospective study over 67 months (June 2009 to January 2015), the number of CT scans done, the time taken for CT and downtime were evaluated. Also, for the first 1000 mobile CT scans, the clinical and radiological records of all patients with TBI who underwent imaging using the mobile CT scanner in the intensive care units (ICUs) were analyzed.
  
  
  RESULTS
  A total of 10,000 mobile CT scans were done on the mobile CT scanner till January 5, 2015. Of the first 1000 patients evaluated, 75.3% had severe TBI, 15.1% had moderate TBI, and 9.6% had mild TBI. 78.1% patients were on ventilator, with 80.2% requiring sedation and 8.4%, an inotropic support. An in situ intracranial pressure monitoring was present in 21.1% of patients. In all, 12.4% of patients had long-bone fractures requiring skeletal traction; and, the tube thoracostomy was in-situ in 7.4%. No adverse events related to line malfunction/pullout occurred. The mean time for the performance of imaging using the mobile CT scan was 11.6 minutes compared with 47.8 minutes when patients were shifted to a conventional CT scan suite. The machine was nonfunctional 94 times, with an average downtime of 4.2 hours (range 2-72 hours). The life-cycle cost per mobile CT scan was Rs. 1340.
  
  
  CONCLUSIONS
  A mobile CT has considerably changed the management response time in the neurosurgical intensive care unit (ICU) setup and decreased patient transfer times and the associated complications. Inclusion of a mobile CT scanner in the armamentarium of a neurosurgeon as a "bedside tool" can dramatically change decision making and the response time. It should be considered as the standard of care in any large-volume emergency department or neurosurgical facility.
authors.affiliation: Department of Neurosurgery, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Agrawal
authors.forename: Renu
authors.initials: R
authors.lastname: Saini
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Singh
authors.forename: Sumit
authors.initials: S
authors.lastname: Sinha
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Gupta
authors.forename: Guru Dutta
authors.initials: GD
authors.lastname: Satyarthee
authors.forename: Mahesh Chandra
authors.initials: MC
authors.lastname: Misra
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging*; D006801:Humans; D007194:India; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers