Utility of Repeat Head Computed Tomography After Blunt Head Trauma: A Systematic Review

Wang, Marjorie C.; Linnau, Ken F.; Tirschwell, David; Hollingworth, William

doi:10.1097/01.ta.0000197385.18452.89

Cited by 84 publications

(77 citation statements)

References 43 publications

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“…These large studies suggest that repeat imaging studies in the early timeframe are rarely beneficial in the absence of clinical deterioration. 1,9,12,20,21 Our study of outpatient imaging is in agreement with this principle, as no patients without clinical deterioration required intervention.…”

Section: Discussionsupporting

confidence: 70%

Results of delayed follow-up imaging in traumatic brain injury

Befeler

Gordon

Khan

et al. 2016

JNS

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OBJECT There is a paucity of scientific evidence available about the benefits of outpatient follow-up imaging for traumatic brain injury patients. In this study, 1 year of consecutive patients at a Level 1 trauma center were analyzed to determine if there is any benefit to routinely obtaining CT of the head at the outpatient follow-up visit. METHODS This single-institution retrospective review was performed on all patients with a traumatic brain injury seen at a Level 1 trauma center in 2013. Demographic data, types of injuries, surgical interventions, radiographic imaging in inpatient and outpatient settings, and outcomes were assessed through a review of the institution’s trauma registry, patient charts, and imaging. RESULTS Five hundred twenty-five patients were seen for traumatic brain injury in 2013 at Regional One Health in Memphis, Tennessee. One hundred eighty-five patients (35%) presented for outpatient follow-up, all with CT scans of the head. Seven of these patients (4%) showed worsening of their intracranial injuries on outpatient imaging studies; however, surgical intervention was recommended for only 3 of these patients (2%). All patients requiring an intervention had neurological deterioration prior to their follow-up appointment. CONCLUSIONS These experiences suggest that outpatient follow-up imaging for traumatic brain injury should be done selectively, as it was not helpful for patients who did not exhibit worsening of neurological signs or symptoms. Furthermore, routine outpatient imaging results in unnecessary resource utilization and radiation exposure.

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Section: Discussionsupporting

confidence: 70%

Results of delayed follow-up imaging in traumatic brain injury

Befeler

Gordon

Khan

et al. 2016

JNS

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“…42 A recent review by Wang et al showed rates of progression of TBI on repeat CT varying between 8% and 67%, but without clarification of associated risk factors or injury types. 43 Better-delineated ICH progression stratification would direct PTP timing strategies, which would then have to be assessed through randomized controlled trials.…”

Section: Resultsmentioning

confidence: 99%

Safety and Efficacy of Early Pharmacological Thromboprophylaxis in Traumatic Brain Injury: Systematic Review and Meta-Analysis

Jamjoom

2013

Journal of Neurotrauma

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Patients with traumatic brain injury (TBI) are at an increased risk of developing venous thromboembolic events (VTE). Pharmacological thromboprophylaxis (PTP) is routinely delayed because of concerns of exacerbating intracranial hemorrhage (ICH). The aim of this review is to examine the literature and assimilate suitable data to assess the safety and efficacy of PTP administered within 72 h in TBI patients. We systematically searched the literature for randomized controlled trials or cohort studies reporting on the timing of PTP in TBI. We dichotomized the timing of PTP to early and late at 72 h post-injury. The rates of VTE and ICH progression were our primary endpoints and were pooled using a fixed-effects model. A total of five retrospective cohort studies were included within the review including a total of 1624 patients, of which 713 received early PTP and 911 received late PTP. Within the early and late group there was a total of 43 and 106 VTE respectively, with a risk ratio of 0.52 (0.37, 0.73). Assessing safety, the relative risk of ICH progression in the early compared with the late PTP group was 0.64 (0.35, 1.14). Based on the available literature, we can tentatively conclude that early PTP (<72 h) reduces the risk of VTE without affecting progression of ICH. However, much work is yet to be done to better clarify ICH subtypes at risk of progression and the implementation of evidence-based guidelines backed up with randomized control trial level evidence.

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“…Other studies have contributed to our understanding of this phenomenon (Allard et al, 2009;Chang et al, 2006;Compagnone et al, 2009;Diaz et al, 1979;Patel et al, 2000;Servadei et al, 2000a;Smith et al, 2007;Stein et al, 1992Stein et al, ,1993Tian et al, 2010;Tseng, 1992;Wang et al, 2006;Young et al, 1984). Together, these studies permit some important generalizations about HPC:…”

Section: Hemorrhagic Progression Of a Contusionmentioning

confidence: 89%

Hemorrhagic Progression of a Contusion after Traumatic Brain Injury: A Review

Kurland

Hong

Aarabi

et al. 2012

Journal of Neurotrauma

278

220

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Кафедра нейрохірургії, Національна медична академія післядипломної освіти імені П.Л. Шупика МОЗ України, Київ, Україна 2 Нейрохірургічне відділення №1, Київська міська клінічна лікарня швидкої медичної допомоги, Київ, Україна Вторинна геморагічна прогресія вогнищ забою головного мозку у пацієнтів при черепно-мозковій травмі Вступ. Вторинні післятравматичні зміни головного мозку (ГМ) часто є визначальними в клінічному перебігу черепно-мозкової травми (ЧМТ). Попередження, виявлення та визначення лікувальної тактики при вторинній геморагічній прогресії забою (ВГПЗ) ГМ актуальні для нейротравматології. Матеріали і методи. Проаналізовані результати лікування потерпілих з ЧМТ, у яких діагностований забій ГМ. Результати. Встановлено, що ВГПЗ виникає у 50% пацієнтів при ЧМТ, як у місцях первинного ушкодження ГМ, так і у віддалених зонах за принципом протиудару протягом 12 год, хоча може виникати і через 3-4 доби після травми. ВГПЗ часто виявляють у пацієнтів з субдуральною гематомою (СДГ). Чим більше вогнище забою, тим більша ймовірність його прогресії та необхідності хірургічної декомпресії. Висновки. ВГПЗ є одним з найважливіших ускладнень після ЧМТ, пов'язана з значним підвищенням ризику клінічного погіршення. Лікувальна тактика залежить від вираженості впливу на навколишні структури та проявів компресійно-дислокаційного синдрому. Ключові слова: тяжка черепно-мозкова травма, забій головного мозку, вторинна геморагічна прогресія вогнищ забою, внутрішньочерепний тиск, ішемічні розлади. Introduction. Secondary posttraumatic changes of the brain often are determining in the clinical flow of traumatic brain injury (TBI). Prevention, detection and determination of treatment strategy at secondary hemorrhagic progression of contusion (SHPC) are very actual for neurotraumatology. Materials and methods. The results of 110 injured persons with TBI were analyzed. Results. It was found that SHPC occurs in 50% patients with TBI, as in areas of primary brain damage as in remote areas on the other side of the brain during 12 h ad also after 3-4 days. SHPC often is revealed in patients with subdural hematoma. The bigger contusion foci, the higher the probability of their progression and the need of surgical decompression. Conclusions. SHPC is one of most important TBI complications associated with considerable risk of clinical deterioration and serious cause of morbidity and lethality. Treatment tactics depends on severity of volumetric effect on surrounding brain structures and manifestations of compression-dislocation syndrome.

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Utility of Repeat Head Computed Tomography After Blunt Head Trauma: A Systematic Review

Cited by 84 publications

References 43 publications

Results of delayed follow-up imaging in traumatic brain injury

Results of delayed follow-up imaging in traumatic brain injury

Safety and Efficacy of Early Pharmacological Thromboprophylaxis in Traumatic Brain Injury: Systematic Review and Meta-Analysis

Hemorrhagic Progression of a Contusion after Traumatic Brain Injury: A Review

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