Is repeat head CT necessary in patients with mild traumatic intracranial hemorrhage

Jonathan Van Ornam, Peter Pruitt, Pierre Borczuk*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Patients with traumatic intracranial hemorrhage (TIH) frequently receive repeat head CT scans (RHCT) to assess for progression of TIH. The utility of this practice has been brought into question, with some studies suggesting that in the absence of progressive neurologic symptoms, the RHCT does not lead to clinical interventions. Methods: This was a retrospective review of consecutive patients with CT-documented TIH and GCS ≥ 13 presenting to an academic emergency department from 2009 to 2013. Demographic, historical, and physical exam variables, number of CT scans during admission were collected with primary outcomes of: neurological decline, worsening findings on repeat CT scan, and the need for neurosurgical intervention. Results: Of these 1126 patients with mild traumatic intracranial hemorrhage, 975 had RHCT. Of these, 54 (5.5% (4.2–7.2 95 CI) had neurological decline, 73 (7.5% 5.9–9.3 95 CI) had hemorrhage progression on repeat CT scan, and 58 (5.9% 4.5–7.6 95 CI) required neurosurgical intervention. Only 3 patients (0.3% 0.1–0.9% 95 CI) underwent neurosurgical intervention due to hemorrhage progression on repeat CT scan without neurological decline. In this scenario, the number of RHCT scans needed to be performed to identify this one patient is 305. Conclusions: RHCT after initial findings of TIH and GCS ≥ 13 leading to a change to operative management in the absence of neurologic progression is a rare event. A protocol that includes selective RHCT including larger subdural hematomas or patients with coagulopathy (vitamin K inhibitors and anti-platelet agents) may be a topic for further study.

Original languageEnglish (US)
Pages (from-to)1694-1698
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume37
Issue number9
DOIs
StatePublished - Sep 2019

Keywords

  • Imaging utilization
  • Mild intracranial hemorrhage
  • Traumatic brain injury
  • Traumatic cranial computerized tomography

ASJC Scopus subject areas

  • Emergency Medicine

Fingerprint Dive into the research topics of 'Is repeat head CT necessary in patients with mild traumatic intracranial hemorrhage'. Together they form a unique fingerprint.

Cite this