Portable CT knocks out doubt of brain injuries in boxers

U.S. researchers aligned with the Nevada State Athletic Commission have found that use of a portable CT scanner can effectively screen professional boxers for intracranial hemorrhage following matches.

Acute subdural hematoma is the most common injury in boxing and the leading cause of boxing fatalities. Early diagnosis of these intracranial injuries in boxers is associated with better outcomes, said Dr. Albert H. Capanna, a Nevada ringside physician and clinical professor of neurosurgery and pediatrics at the University of Nevada School of Medicine.

Capanna and colleagues used a 700-pound (318 kg) portable eight-slice CT scanner to screen eight boxers within five minutes of the conclusion of their bouts. Noncontrast CT with facial bone reconstruction was performed and interpreted by a fellowship-trained neuroradiologist.

While the researchers found no clinical signs or symptoms of injury in any athletes, CT demonstrated in one boxer, who lost by a technical knockout, a 6.2-mm acute subdural hematoma with positive evidence of midline shift of 4.2 mm. Surgical evacuation is indicated in the management of acute subdural hematomas greater than 10 mm in thickness or associated with a midline shift of 5 mm.

The patient was promptly admitted to a nearby hospital, and the subdural hematoma improved over the subsequent two days, including complete resolution of the previous midline shift by discharge on the third day.

The Nevada state legislature has provided funding to the State Athletic Commission to have CT imaging available at athletic venues for immediate use in screening athletes with head injury. However, further studies are needed to risk-stratify athletes before including them in long-term screening protocols because of the cumulative radiation dose associated with this practice, Capanna said.