Introduction: When an initial CT scan reveals an intracranial hemorrhage following traumatic brain injury, the standard of care in most institutions is to schedule a repeat CT scan within 24 hours to rule out any progression of the bleed, regardless of the neurological status. While repeating the CT is clearly indicated to assess a deteriorating patient, in this study, we evaluate the utility of routine follow-up CT in changing the management after mild head injury.
Methods: The trauma database at our center was reviewed for patients admitted between April 2006 and 2011 following traumatic mild head injury with positive initial CT finding and scheduled repeat scan. Two independent reviewers performed an electronic search of MEDLINE and EMBASE for similar published studies. We divided the patients (from the current series and the literature) who required intervention following the repeat CT into two groups. Group A, included patients who had a change in management based on neurological exam. Group B, included patients who received intervention based exclusively on the CT results. We analyzed the data of each group using a random effect model.
Results: Overall, 15 studies and 445 patients from the current series met our eligibility criteria. In Group A, the weighted proportion was 2.7% (95% CI 1.7 – 3.9%), p=0.0003; in Group B, the weighted proportion was found to be 0.6% (95% CI 0.3 – 1%), p=0.2125. The comparative analysis of the intervention rates of both groups resulted in a statistically significant difference (p<0.001).
Conclusions: The available evidence indicates that it is unnecessary to schedule a repeat CT scan following mild head injury when patients are unchanged or improving neurologically. In the absence of supporting data, we question the value of routine repeat CTs for patients with traumatic brain injury despite a stable neurological status, given the associated accumulative increase in cost and risks.
Patient Care: We address the associated accumulative increase in risks and cost when using CTs unnecessarily for mild head injury patients.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance for neurological exam in predicting the need of intervention after mild head injury.
2) Discuss the associated risks of the liberal use of CT scans.
3) Identify the indications for repeating CT following mild head injury and the value of routine follow-up CTs.