Journal article
A three-year prospective study of repeat head computed tomography in patients with traumatic brain injury
Journal of the American College of Surgeons, Vol.219(1), pp.45-51
07/01/2014
DOI: 10.1016/j.jamcollsurg.2013.12.062
PMID: 24745622
Abstract
A definitive consensus on the standardization of practice of a routine repeat head CT (RHCT) scan in patients with traumatic intracranial hemorrhage is lacking. We hypothesized that in examinable patients without neurologic deterioration, RHCT scan does not lead to neurosurgical intervention (craniotomy/craniectomy).
This was a 3-year prospective cohort analysis of patients aged 18 years and older, without antiplatelet or anticoagulation therapy, presenting to our level 1 trauma center with intracranial hemorrhage on initial head CT and a follow-up RHCT. Neurosurgical intervention was defined by craniotomy/craniectomy. Neurologic deterioration was defined as altered mental status, focal neurologic deficits, and/or pupillary changes.
A total of 1,129 patients were included. Routine RHCT was performed in 1,099 patients. The progression rate was 19.7% (216 of 1,099), with subsequent neurosurgical intervention in 4 patients. Four patients had an abnormal neurologic examination, with a Glasgow Coma Scale (GCS) of ≤8 requiring intubation. Thirty patients had an RHCT secondary to neurologic deterioration; 53% (16 of 30) had progression on RHCT, of which 75% (12 of 16) required neurosurgical intervention. There was an association between deterioration in neurologic examination and need for neurosurgical intervention (odds ratio 3.98; 95% CI 1.7 to 9.1). The negative predictive value of a deteriorating neurologic examination in predicting the need for neurosurgical intervention was 100% in patients with GCS > 8.
Routine repeat head CT scan is not warranted in patients with normal neurologic examination. Routine repeat head CT scan does not supplement the need for neurologic examination for determining management in patients with traumatic brain injury.
Details
- Title: Subtitle
- A three-year prospective study of repeat head computed tomography in patients with traumatic brain injury
- Creators
- Bellal Joseph - American College of SurgeonsHassan Aziz - American College of SurgeonsViraj Pandit - University of ArizonaNarong Kulvatunyou - University of ArizonaAmmar Hashmi - University of ArizonaAndrew Tang - University of ArizonaMoutamn Sadoun - University of ArizonaTerence O'Keeffe - University of ArizonaGary Vercruysse - University of ArizonaDonald J Green - University of ArizonaRandall S Friese - University of ArizonaPeter Rhee - University of Arizona
- Resource Type
- Journal article
- Publication Details
- Journal of the American College of Surgeons, Vol.219(1), pp.45-51
- DOI
- 10.1016/j.jamcollsurg.2013.12.062
- PMID
- 24745622
- ISSN
- 1072-7515
- eISSN
- 1879-1190
- Language
- English
- Date published
- 07/01/2014
- Academic Unit
- Surgery
- Record Identifier
- 9984701647702771
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