Repeat CTs in Normal Neurological Patients Following TBI Unnecessary

Routine repeat head CT scans are not necessary for patients with blunt traumatic brain injury (TBI) who have normal neurological examinations, according to a study published in the Journal of the American College of Surgeons.

Researchers from the University of Arizona performed a three-year prospective cohort analysis of adults who presented to a level 1 trauma center with intracranial hemorrhage on initial head CT and a follow-up repeat head CT (RHCT) scan six hours after presentation. Patients in the study were not on antiplatelet or anticoagulation therapy.

All patients underwent neurological examination upon arrival and every two hours following. The primary outcome was the need for neurosurgical intervention, defined as craniotomy/craniectomy. Patients who were found to have deteriorating neurological examinations (altered mental status, focal neurologic deficits and/or papillary changes) received RHCT independent of the protocol.

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A total of 1,129 patients, mean age 45.9, were enrolled into the study. The most common intracranial hemorrhages noted by CT were subarachnoid hemorrhage (53.3 percent), intraparenchymal hemorrhage (53.3 percent) and subdural hemorrhage (48.7 percent). Of the 1,129 patients, 209 (18.5 percent) had displaced skull fractures.

Routine RHCT was performed on 1,099 patients. The progression rate was 19.7 percent (216 patients) and four of the patients underwent neurosurgical intervention. The four patients scored eight or lower on the Glasgow Coma Scale (GCS) and required intubation. The 30 other patients underwent RHCT because of deteriorating neurological status. Of these patients, 53 percent (16 patients) had progression on RHCT, of which 75 percent (12 of the 16 patients) required neurosurgical intervention.

“There was an association between deterioration in neurologic examination and need for neurosurgical intervention,” the authors wrote. “The negative predictive value of a deteriorating neurological examination in predicting the need for neurosurgical intervention was 100 percent in patients with GCS of higher than 8.”

The researchers concluded that repeat head CT scans were not necessary for patients with blunt mild traumatic brain injury who were otherwise normal neurologically.