Introduction: The utility of the routine follow up head CT in complicated mild TBI is questionable. However it is still considered standard of care in many medical centers. We set out to analyze in a prospective fashion how often routine follow up head CTs lead to a surgical intervention.
Methods: Over a three-year period data on patients presenting with a mild TBI and a head CT positive for TBI were enrolled prospectively in database. All patient must have been deemed non-operative after their first head CT, have a follow up CT scan during their hospital stay and a GCS of 13 to 15.
Results: Overall 433 consecutive patients were enrolled in the study. The intracranial pathology was stable in 62% of follow up CT scans, decreased in 18% and increased in 16%. In 4 % only the radiology report and not the images were available so comparison cold not be made. Overall 2.31% (n=10) of patients underwent a craniotomy. In the operative group was a significant higher rate of subdural hematomas (90% versus 41% p=0.0012) and contusions (55% versus 22% p=0.013). The mean age between the two groups was not significantly different. The time between fist and second CT was significantly different 10 hours and 30 minutes versus 14 hours and 36 minutes (p=0.035).
Conclusions: With this prospective observational cohort study we could show that the event rate for craniotomy after a non-operative first head CT in the setting of complicated mild TBI is low, 2.53 %. The fact there was a significantly shorted tine between first and second head CT indicates that clinical concern prompted the second head CT in the operative group.
Overall this data support the notion that a routine follow up head CT has not clinical value but clinical observation for at least 6 hours does.
Patient Care: Unnecessary head Ct scan be prevented
Learning Objectives: Utility of the Routine follow-up head CT in complicated mild TBI