Analysis of Repeated CT Scan Need in Blunt Head Trauma

Eroğlu, Serkan Emre; Onur, Özge; Ozkaya, Sefer; Denizbaşı, Arzu; Demır, Hasan; Özpolat, Çiğdem

doi:10.1155/2013/916253

Cited by 11 publications

(15 citation statements)

References 11 publications

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“…Serkan Emre et al study showed that the first CT scan of head trauma patients in EDs are good guides for the status of patients with mild head trauma patients. Repeated CT scans after 6 hours of observation in ED room were not necessary if first CT was normal in most situations [16]. Whereas, this result was consistent with results of this study.…”

Section: Discussionsupporting

confidence: 91%

“…Controversy exists as to the role of a routine repeat head Computed Tomography (CT) for patients with traumatic brain injury and an initially abnormal head CT. Brown CV et al reported that Patients with any head injury (mild, moderate, or severe) should undergo a repeat head CT after neurological deterioration, because it leads to intervention in over one-third of patients. Routine repeat head CT is indicated for patients with a GCS score ≤8, as results might lead to intervention without neurological change [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

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Roqia Al-Azzani (TBI) Serial CT Control Analysis of Necessity and Outcome

azzani

2018

OAJNN

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Background: TBI is a leading cause of death and disability around the globe. The Glasgow Coma Scale (GCS) and the Glasgow Outcome Scale (GOS) are the most widely used methods of describing TBI and measure of outcome following head injury. Computed tomography (CT) has become the current standard for diagnosing intracranial pathology following head trauma The aims of this study were to identify radiological features of patients in who repeated CT imaging would be useful and to identify the outcome of head trauma, according to Glasgow Outcome Scale .In addition to make a development of a stratification protocol of patients into appropriate risk groups avoiding over or under investigation in such patients. Method:A retrospective case series study analysis of head trauma patients presenting to the 48 Medical Model Compound Hospital between January and March 2017. All patients requiring a CT head on admission and then a repeat (control) CT at 6 hours or more were included. Their GCS was assessed twice before undergoing the control brain CT scans; once they arrived at the hospital, then followed by another assessment after 3 hours and assessed GOS on discharge.Results: Of the total 27-control brain CTs, it was seen there were no different in 23 (85.2 %). In CTs of anther 1 (3.7%) there was increasing in the pathology present. And in the anther 3 (11.11%) there were a decrease in the pathology. Over all, all patients had clinical improvement and good outcome depending on of GCS and Glasgow Outcome Scale respectively. Conclusion:To conclude, control brain CT scans after 6 hours or more from the event are not necessary in case the initial CT was normal or when there is no clinical deterioration Background. Traumatic Brain Injury (TBI) is defined as damage to the brain resulting from external mechanical force, such as rapid acceleration or deceleration, impact, blast waves, or penetration by a projectile and presents a major worldwide social, economic, and health problem [1]. TBI is a leading cause of death and disability around the globe [2]. In developing countries, the incidence of traumatic brain injury is increasing as traffic increases, besides Other confounding factors such as industrialization, falls and ballistic trauma [3]. The most widely used methods of describing TBI are the Glasgow Coma Scale (Figure 1). It is predictive of mortality in a general TBI population. The Glasgow Outcome Scale (Figure 2) is the most widely used and accepted measure of outcome following head injury [4][5][6].Computed Tomography (CT) is the preferred radiologic test in TBI it is quick, accurate, and widely available, it has become the current standard for diagnosing intracranial pathology following head trauma. And the role of the initial brain CT scan and of unscheduled repeat brain CTs when a neurological deterioration occurs is well established. But using of routine serial head CT in patients without neurologic deterioration is not supported by the findings of Brown et al [7][8][9][10].The aims of this study are to identify radiolo...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Roqia Al-Azzani (TBI) Serial CT Control Analysis of Necessity and Outcome

azzani

2018

OAJNN

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“…Performing a repeat head computed tomography (CT) after an initial negative head CT is one strategy to evaluate delayed intracranial hemorrhage. Evidence has shown that most DICHs occur within 6–24 h of injury [ 21 , 22 ], although a recent large multicenter prospective study found that delayed hemorrhages occurred up to 5 days after injury [ 19 ]. There is no clear consensus on whether or not to routinely perform repeat head CTs in elderly patients with minor injuries on ACAP therapies, although this is the standard practice in many European trauma centers [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Delayed intracranial hemorrhage in elderly anticoagulated patients sustaining a minor fall

et al. 2018

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BackgroundFalls are a common cause of hospitalization, morbidity, and mortality among the elderly in the United States. Evidence-based imaging recommendations for evaluation of delayed intracranial hemorrhage (DICH) are not generally agreed upon. The purpose of this project was to evaluate the incidence of DICH detected by head computer tomography (CT) among an elderly population on pre-injury anticoagulant or antiplatelet (ACAP) therapy.MethodsData from a Level 1 Trauma Center trauma registry was used to assess the incidence of DICH in an elderly population of patients (≥65 years) who sustained a minor fall while on pre-injury ACAP medications. Counts and percentages are reported.ResultsData on 1076 elderly trauma patients were downloaded, of which 838 sustained a minor fall and 513 were found to be using a pre-injury ACAP medication. One patient (0.46%) with a DICH was identified out of 218 patients who received a routine repeat head CT. Aspirin and warfarin were the most common pre-injury ACAP medications and 19.27% (42/218) of patients were found to be using multiple ACAP medications.ConclusionsUniversal screening protocols promote immediate-term patient safety, but do so at a great expense with respect to health expenditures and increased radiation exposure. This analysis highlights the need for an effective risk assessment tool for DICH that would reduce the burden of unnecessary screenings while still identifying life-threatening intracranial hemorrhages in affected patients.

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“…This further highlights the importance of utilizing metrics, such as ECG or PPG waveform feature analysis, that are resilient to factors that impact the reliability of the GCS assessment. Serial CT imaging provides additional information regarding clinically silent progression of injury ( 37 – 39 ) with the aim of capturing signs of neurologic worsening which can lead to early medical and surgical interventions even before the clinical symptoms manifest ( 40 ). Despite our results indicating additional benefit of scoring severity of injury by CT imaging, a multicenter prospective study as well as several large single center cohort studies have failed to find factors that reliably predicted the correlation between ND and serial CT imaging ( 41 – 44 ).…”

Section: Discussionmentioning

confidence: 99%

Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury

Melinosky

Yang

et al. 2018

Front. Neurol.

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Background: In the acute resuscitation period after traumatic brain injury (TBI), one of the goals is to identify those at risk for secondary neurological decline (ND), represented by a constellation of clinical signs that can be identified as objective events related to secondary brain injury and independently impact outcome. We investigated whether continuous vital sign variability and waveform analysis of the electrocardiogram (ECG) or photoplethysmogram (PPG) within the first hour of resuscitation may enhance the ability to predict ND in the initial 48 hours after traumatic brain injury (TBI).Methods: Retrospective analysis of ND in TBI patients enrolled in the prospective Oximetry and Noninvasive Predictors Of Intervention Need after Trauma (ONPOINT) study. ND was defined as any of the following occurring in the first 48 h: new asymmetric pupillary dilatation (>2 mm), 2 point GCS decline, interval worsening of CT scan as assessed by the Marshall score, or intervention for cerebral edema. Beat-to-beat variation of ECG or PPG, as well as waveform features during the first 15 and 60 min after arrival in the TRU were analyzed to determine physiologic parameters associated with future ND. Physiologic and admission clinical variables were combined in multivariable logistic regression models predicting ND and inpatient mortality.Results: There were 33 (17%) patients with ND among 191 patients (mean age 43 years old, GCS 13, ISS 12, 69% men) who met study criteria. ND was associated with ICU admission (P < 0.001) and inpatient mortality (P < 0.001). Both ECG (AUROC: 0.84, 95% CI: 0.76,0.93) and PPG (AUROC: 0.87, 95% CI: 0.80, 0.93) analyses during the first 15 min of resuscitation demonstrated a greater ability to predict ND then clinical characteristics alone (AUROC: 0.69, 95% CI: 0.59, 0.8). Age (P = 0.02), Marshall score (P = 0.001), penetrating injury (P = 0.02), and predictive probability for ND by PPG analysis at 15 min (P = 0.03) were independently associated with inpatient mortality.Conclusions: Analysis of variability and ECG or PPG waveform in the first minutes of resuscitation may represent a non-invasive early marker of future ND.

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Analysis of Repeated CT Scan Need in Blunt Head Trauma

Cited by 11 publications

References 11 publications

Roqia Al-Azzani (TBI) Serial CT Control Analysis of Necessity and Outcome

Roqia Al-Azzani (TBI) Serial CT Control Analysis of Necessity and Outcome

Delayed intracranial hemorrhage in elderly anticoagulated patients sustaining a minor fall

Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury

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