Predictors of New Findings on Repeat Head CT Scan in Blunt Trauma Patients with an Initially Negative Head CT Scan

Muakkassa, Farid; Marley, Robert; Paranjape, Charudutt; Horattas, Elya; Salvator, Ann; Muakkassa, Kamel F.

doi:10.1016/j.jamcollsurg.2012.02.004

Cited by 9 publications

(6 citation statements)

References 18 publications

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“…In studies done on patients with positive initial CT scan, some patients had a change in clinical management [2, 7]. Our study is consistent with previous studies in patients with a positive initial CT scans.…”

Section: Discussionsupporting

confidence: 90%

“…Initial evaluation includes a careful neurological examination and computed tomography (CT) scans of the brain [1]. CT scans is the represent the initial study of choice in current practice to determine the type, extent and severity of traumatic brain injury as well as to determine the management protocol [2]. The role of the initial brain CT scan and of unscheduled repeat brain CTs when a neurological deterioration occurs is well established [3].…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Repeated CT Scan Need in Blunt Head Trauma

Eroğlu

Onur

Ozkaya

et al. 2013

Emergency Medicine International

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Background. Computed tomography (CT) is a vital tool in the workup of patients with closed head trauma. The aim of this study was to investigate the necessity of serial CT scans in patients with blunt head trauma. Methods. This is a retrospective study analyzing trauma patients between January and June 2012. Data were analysed by using frequencies, Kolmogorov-Smirnov (K-S), and Chi-square tests. Results. Of the total 351 control Head CTs, it was seen there were no different in 346 (98.6%). In CTs of another 3 patients (0.9%), there were increasing or new, in the other 2 (0.6%) there was a decrease in the pathology present. Of 24 (6.8%) patients who had a hemorrhage in the first CT, there was an increase in the hemorrhage in one of them, a decrease of the pathology in 2 of them. Of 27 (7.7%) patients who had fracture in first CT, 2 had a new intracranial hemorrhage. The relation of the results between the first and second CTs were statistically significant (P < 0.001, χ 2 test). Conclusion. Repeated CT scans after 6 hours in EDs observation rooms are not necessary if first CT is normal in most situations. Special attention may be needed in patients with an underlying chronic disease.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Analysis of Repeated CT Scan Need in Blunt Head Trauma

Eroğlu

Onur

Ozkaya

et al. 2013

Emergency Medicine International

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Section: Discussionmentioning

confidence: 99%

“…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 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 [11]. In addition to make a development of a stratification protocol of patients into appropriate risk groups avoiding over or under investigation in such patients.…”

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confidence: 95%

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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“…Therefore initial cCT scans might be unremarkable despite intracranial trauma sequel [12, 14]. For that reason some trauma centres schedule the second scan 6 to 24 hours after the admission scan in order to detect early progression of brain injury [12, 15–17]. …”

Section: Introductionmentioning

confidence: 99%

Routine Follow-Up Cranial Computed Tomography for Deeply Sedated, Intubated, and Ventilated Multiple Trauma Patients with Suspected Severe Head Injury

Wurmb

Schlereth

Kredel

et al. 2014

BioMed Research International

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Background. Missed or delayed detection of progressive neuronal damage after traumatic brain injury (TBI) may have negative impact on the outcome. We investigated whether routine follow-up CT is beneficial in sedated and mechanically ventilated trauma patients. Methods. The study design is a retrospective chart review. A routine follow-up cCT was performed 6 hours after the admission scan. We defined 2 groups of patients, group I: patients with equal or recurrent pathologies and group II: patients with new findings or progression of known pathologies. Results. A progression of intracranial injury was found in 63 patients (42%) and 18 patients (12%) had new findings in cCT 2 (group II). In group II a change in therapy was found in 44 out of 81 patients (54%). 55 patients with progression or new findings on the second cCT had no clinical signs of neurological deterioration. Of those 24 patients (44%) had therapeutic consequences due to the results of the follow-up cCT. Conclusion. We found new diagnosis or progression of intracranial pathology in 54% of the patients. In 54% of patients with new findings and progression of pathology, therapy was changed due to the results of follow-up cCT. In trauma patients who are sedated and ventilated for different reasons a routine follow-up CT is beneficial.

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Predictors of New Findings on Repeat Head CT Scan in Blunt Trauma Patients with an Initially Negative Head CT Scan

Cited by 9 publications

References 18 publications

Analysis of Repeated CT Scan Need in Blunt Head Trauma

Analysis of Repeated CT Scan Need in Blunt Head Trauma

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

Routine Follow-Up Cranial Computed Tomography for Deeply Sedated, Intubated, and Ventilated Multiple Trauma Patients with Suspected Severe Head Injury

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