Scheduled Repeat CT Scanning for Traumatic Brain Injury Remains Important in Assessing Head Injury Progression

Bradley W. Thomas, Vicente A. Mejia, Robert Maxwell, Benjamin W. Dart, Philip W. Smith, Michael R. Gallagher, Sean C. Claar, Stephen H. Greer, Donald E. Barker

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Scheduled repeat brain CT (SRBCT) is used to monitor progression of traumatic brain injury (TBI). Previous studies have suggested that routine SRBCT can be replaced by an unscheduled repeat brain CT after deterioration on serial neurological examination. In this study, we evaluated if SRBCT has a role in the management of TBI. Study Design: Retrospective observational study of 1,019 consecutive adult patients admitted to a Level I trauma center with CT evidence of TBI on initial brain CT (IBCT). All patients with intracranial pathology on IBCT were scheduled for SRBCT and underwent sequential neurological physical examinations. Interventions (surgical or medical) after IBCT, SRBCT, or neurological change were recorded. Results: One thousand nineteen patients with IBCT evidence of TBI were identified from the trauma registry during a 50-month study period beginning in November 2001. Eighty-six (8.9%) of these patients went directly for craniotomy. After exclusions, 887 patients were analyzed. A total of 692 (78%) patients had a no worse first SRBCT and neurologic changes requiring intervention later developed in 11 (1.6%) of these patients. One hundred ninety-five (22%) patients had a worse first SRBCT, with 14 (7.2%) requiring immediate intervention. Seven (3.6%) worse first SRBCT patients had a subsequent SRBCT that worsened, leading to an intervention. A neurologic change that precipitated an intervention developed subsequently in an additional 19 (9.7%) patients with a worse first SRBCT. Chi-square analysis demonstrated that a first SRBCT that was worse was more likely to result in an intervention than if the first SRBCT was no worse. Conclusions: A worse SRBCT is more likely to result in neurologic intervention. SRBCT remains useful in assessing patients with TBI.

Original languageEnglish (US)
Pages (from-to)824-830
Number of pages7
JournalJournal of the American College of Surgeons
Volume210
Issue number5
DOIs
StatePublished - May 1 2010
Externally publishedYes

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Craniocerebral Trauma
Brain
Nervous System
Traumatic Brain Injury
Neurologic Examination
Craniotomy
Trauma Centers

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Scheduled Repeat CT Scanning for Traumatic Brain Injury Remains Important in Assessing Head Injury Progression. / Thomas, Bradley W.; Mejia, Vicente A.; Maxwell, Robert; Dart, Benjamin W.; Smith, Philip W.; Gallagher, Michael R.; Claar, Sean C.; Greer, Stephen H.; Barker, Donald E.

In: Journal of the American College of Surgeons, Vol. 210, No. 5, 01.05.2010, p. 824-830.

Research output: Contribution to journalArticle

Thomas, Bradley W. ; Mejia, Vicente A. ; Maxwell, Robert ; Dart, Benjamin W. ; Smith, Philip W. ; Gallagher, Michael R. ; Claar, Sean C. ; Greer, Stephen H. ; Barker, Donald E. / Scheduled Repeat CT Scanning for Traumatic Brain Injury Remains Important in Assessing Head Injury Progression. In: Journal of the American College of Surgeons. 2010 ; Vol. 210, No. 5. pp. 824-830.
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abstract = "Background: Scheduled repeat brain CT (SRBCT) is used to monitor progression of traumatic brain injury (TBI). Previous studies have suggested that routine SRBCT can be replaced by an unscheduled repeat brain CT after deterioration on serial neurological examination. In this study, we evaluated if SRBCT has a role in the management of TBI. Study Design: Retrospective observational study of 1,019 consecutive adult patients admitted to a Level I trauma center with CT evidence of TBI on initial brain CT (IBCT). All patients with intracranial pathology on IBCT were scheduled for SRBCT and underwent sequential neurological physical examinations. Interventions (surgical or medical) after IBCT, SRBCT, or neurological change were recorded. Results: One thousand nineteen patients with IBCT evidence of TBI were identified from the trauma registry during a 50-month study period beginning in November 2001. Eighty-six (8.9{\%}) of these patients went directly for craniotomy. After exclusions, 887 patients were analyzed. A total of 692 (78{\%}) patients had a no worse first SRBCT and neurologic changes requiring intervention later developed in 11 (1.6{\%}) of these patients. One hundred ninety-five (22{\%}) patients had a worse first SRBCT, with 14 (7.2{\%}) requiring immediate intervention. Seven (3.6{\%}) worse first SRBCT patients had a subsequent SRBCT that worsened, leading to an intervention. A neurologic change that precipitated an intervention developed subsequently in an additional 19 (9.7{\%}) patients with a worse first SRBCT. Chi-square analysis demonstrated that a first SRBCT that was worse was more likely to result in an intervention than if the first SRBCT was no worse. Conclusions: A worse SRBCT is more likely to result in neurologic intervention. SRBCT remains useful in assessing patients with TBI.",
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