Introduction: Benefit of routine repeat head computed tomography (RHCT) in minimal head injury (MHI) patients (GCS greater than 12) has been debated. With increasing concern over the use of hospital resources, our institution undertook several studies revealing little benefit from routine RHCTs. As a result we devised a new single CT protocol whereby MHI patients with an intracranial hemorrhage (ICH) and a GCS=15 at 24 hours do not receive a routine RHCT. This study was undertaken to determine the safety and outcomes of this protocol.
Methods: Retrospective cohort study of patients >/= 18 years-old admitted to our institution over 48 months with MHI and ICH on initial CT. Patients were included if they had a GCS=15 at 24 hours and did not receive a RHCT, those that did receive a routine RHCT were excluded for protocol deviation. Exclusion criteria included anticoagulation therapy, delayed presentation after injury, or incomplete records.
Results: 533 patients were retrieved, 391 (73%) were excluded, 48 (9%) deviated from protocol, and 94 (18%) met criteria. Of the 94, median age was 34 (IQR,29.5), 78 (83%) were male, and most common ICH was a subdural hemorrhage (72%).
3 (3%) patients suffered delayed neurologic decline (change in mental status prompting RHCT greater than or equal to 24 hours from presentation). All 3 had worsened findings on RHCT, 0/3 required any neurosurgical intervention, and 2/3 required upgrading of care without medical intervention (Table 1). Median time to deterioration was 70 hours (IQR, 9). All three patients recovered to full neurologic function prior to discharge.
Conclusions: This new institutional single CT protocol for patients with MHI and ICH resulted in no delay of neurosurgical intervention or adverse neurologic outcome, indicating its safety. Larger prospective patient multicenter series are need to further validate this conclusion in this select group of MHI patients.
Patient Care: This retrospective study investigates the effectiveness of the stated protocol and prevents unnecessary imaging and use of resources.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Understand the clinical characteristics and risk factors leading to delayed neurological deterioration, 2) Discuss when to forego RHCT in patients with normal neurological exam after 24 hours and 3) Identify or investigate similar protocols preventing unnecessary RHCT.
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