title: Utility of repeat head computed tomography after mild head trauma: influence on short- and long-term prognosis and health-related quality of life.
abstract: The aim of this study was to investigate the utility of repeat head CT in a large population of patients with non-isolated blunt mild head trauma (MTBI), especially in the presence of intracranial injury. This is a study of a cohort of 478 non-isolated MTBI patients admitted to the High Dependency Unit of the Emergency Department of the University-Hospital of Florence from July 2008 to December 2013. Results of initial and subsequent head CT scans, and indications for repeat head CT scan (routine vs. neurologic change) were recorded. The study population was divided into two subgroups: 28 (6 %) patients with neurological change or persistently reduced GCS (group GCS-) and 450 (94 %) patients with normal or improving GCS (group GCS+). After 6 months from the event, a telephone interview using SF12 questionnaire was conducted. Among GCS- patients, the admission CT scan showed intracranial lesions (ICI) in 16 (57 %) patients; only two patients had a TBI-related neurosurgical intervention. Among GCS+ patients, the first CT scan showed an ICI in 133 patients; in a significant proportion of patients with ICI at the first CT scan, the injury worsened (40/133, 30 %, p < 0.0001). However, no GCS+ patient had any neurosurgical intervention. We observed a significant reduction in both MCS and PCS scores after the injury compared with the previous period. The number of repeat CT scan was high in patients who presented ICI at the first CT scan; however, no patient with ICI and normal or improving GCS score needed a neurosurgical intervention.
authors.affiliation: High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Francesca Innocenti, Lg. Brambilla 3, 50134, Florence, Italy. innocentif@aou-careggi.toscana.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Innocenti
authors.affiliation: High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Francesca Innocenti, Lg. Brambilla 3, 50134, Florence, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Del Taglia
authors.affiliation: High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Francesca Innocenti, Lg. Brambilla 3, 50134, Florence, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Tassinari
authors.affiliation: High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Francesca Innocenti, Lg. Brambilla 3, 50134, Florence, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Trausi
authors.affiliation: High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Francesca Innocenti, Lg. Brambilla 3, 50134, Florence, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Conti
authors.affiliation: High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Francesca Innocenti, Lg. Brambilla 3, 50134, Florence, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zanobetti
authors.affiliation: High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Francesca Innocenti, Lg. Brambilla 3, 50134, Florence, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pini
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data; D006257:Head / Q000502:physiology; D016489:Head Injuries, Closed / Q000175:diagnosis* / Q000523:psychology; D006304:Health Status; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000523:psychology / Q000592:standards / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000503:physiopathology
keywords: Health-related quality of life; Intracranial lesions; Mild traumatic brain injury; Prognosis; Repeat head CT scan