Isolated subarachnoid hemorrhage in mild traumatic brain injury: is a repeat CT scan necessary? A single-institution retrospective study

BackgroundAlthough there are eight factors known to indicate a high risk of intracranial hemorrhage (ICH) in mild traumatic brain injury (TBI), identification of the strongest of these factors may optimize the utility of brain CT in clinical practice. This study aimed to evaluate the predictors of ICH based on baseline characteristics/mode of injury, indications for brain CT, and a combination of both to determine the strongest indicator.MethodsThis was a descriptive, retrospective, analytical study. The inclusion criteria were diagnosis of mild TBI, high risk of ICH, and having undergone a CT scan of the brain. The outcome of the study was any type of ICH. Stepwise logistic regression analysis was used to find the strongest predictors according to three models: (1) injury pattern and baseline characteristics, (2) indications for CT scan of the brain, and (3) a combination of models 1 and 2.ResultsThere were 100 patients determined to be at risk of ICH based on indications for CT of the brain in patients with acute head injury. Of these, 24 (24.00%) had ICH. Model 1 found that injury due to motor vehicle crash was a significant predictor of ICH, with an adjusted OR (95% CI) of 11.53 (3.05 to 43.58). Models 2 and 3 showed Glasgow Coma Scale (GCS) score of 13 to 14 after 2 hours of observation and open skull or base of skull fracture to be independent predictors, with adjusted OR (95% CI) of 11.77 (1.32 to 104.96) and 5.88 (1.08 to 31.99) according to model 2.DiscussionOpen skull or base of skull fracture and GCS score of 13 to 14 after 2 hours of observation were the two strongest predictors of ICH in mild TBI.Level of evidenceIII.

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Evaluating mild traumatic brain injury management at a regional emergency department

Injury Prevention ◽

10.1136/injuryprev-2018-042865 ◽

2018 ◽

Vol 24 (5) ◽

pp. 390-394

Author(s):

Ashlee Maree Brown ◽

Dara M Twomey ◽

Anna Wong Shee

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Best Practice ◽

Medical Service ◽

Regional Health ◽

Diagnosis Codes ◽

Retrospective Audit ◽

Concussive Injury

BackgroundEmergency departments (EDs) are usually the first point of contact, and often the only medical service available, for patients with mild traumatic brain injury (mTBI) in rural and regional areas. Clinical practice guidelines (CPGs) have been created to ensure best practice management of mTBI in EDs. Adherence to mTBI CPGs has rarely been evaluated in rural and regional areas.AimThe aim of this paper was to assess a regional health service’s adherence to their mTBI CPG.MethodsThis was a 12-month retrospective audit of 1280 ED records of patients ≥16 years presenting with mTBI to a regional Australian ED. Case selection used the Victorian Admitted Episodes Dataset codes for suspected head injury: principal diagnosis codes (S00-T98), concussive injury recorded in diagnosis codes (S06.00-S06.05) and unintentional external cause code (V00-X59). The data were collected to determine 4-hour observation rates, CT scan rates, safe discharge and appropriate referral documentation.ResultsFewer people received a CT scan than qualified (n=245, 65.3%), only 45% had 4-hour observations recorded, safe discharge was documented in 74.1% of cases and 33% received educational resources.Discussion/conclusionSeveral key elements for the management of mTBI were under-recorded, particularly 4-hour observations, safe discharge and education. Acquired brain injury clinic referrals were received in overwhelmingly fewer cases than had a CT scan (n=19, 6.3%). Overall, this study suggests that the regional health service does not currently fully adhere to the CPG and that the referral services are potentially underutilised.

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Cost-Effectiveness Analysis of Head Computed Tomography in Children with Mild Traumatic Brain Injury: A Retrospective Study

International journal of Nutrition Pharmacology Neurological Diseases ◽

10.4103/ijnpnd.ijnpnd_8_21 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

Thara Tunthanathip ◽

Nakornchai Phuenpathom ◽

Sakchai Sae-heng ◽

Thakul Oearsakul ◽

Ittichai Sakarunchai ◽

...

Keyword(s):

Computed Tomography ◽

Traumatic Brain Injury ◽

Retrospective Study ◽

Cost Effectiveness ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis ◽

Head Computed Tomography

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Patients with mild traumatic brain injury: Immediate and long-term outcome compared to intra-cranial injuries on CT scan

Brain Injury ◽

10.1080/02699050600832569 ◽

2006 ◽

Vol 20 (11) ◽

pp. 1131-1137 ◽

Cited By ~ 31

Author(s):

Charlotte Sadowski-Cron ◽

Jörg Schneider ◽

Pascal Senn ◽

Bogdan P. Radanov ◽

Pietro Ballinari ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Term Outcome ◽

Long Term Outcome

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Admission Variables Associated with a Favorable Outcome after Mild Traumatic Brain Injury

The American Surgeon ◽

10.1177/000313481608201008 ◽

2016 ◽

Vol 82 (10) ◽

pp. 898-902 ◽

Cited By ~ 4

Author(s):

Alexander C. Schwed ◽

Monica M. Boggs ◽

Drew Watanabe ◽

David S. Plurad ◽

Brant A. Putnam ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Subarachnoid Hemorrhage ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Univariate Analysis ◽

Vital Signs ◽

Multivariate Regression Analysis ◽

Favorable Outcome ◽

Imaging Results ◽

Admission Variables

Consensus is lacking for ideal management of mild traumatic brain injury (mTBI) with intracranial hemorrhage (ICH). Patients are often monitored in the intensive care unit (ICU) without additional interventions. We sought to identify admission variables associated with a favorable outcome (ICU admission for 24 hours, no neurosurgical interventions, no complications or mortality) to divert these patients to a non-ICU setting in the future. We reviewed all patients with mTBI [Glasgow Coma Scale (GCS) = 13–15] and concomitant ICH between July 1, 2012, and June 30, 2015. Variables collected included demographics, vital signs, neurologic examination, imaging results, ICU course, mortality, and disposition. Of 201 patients, 78 (39%) had a favorable outcome. On univariate analysis, these patients were younger, more often had an isolated subarachnoid hemorrhage, and were more likely to have a GCS of 15 at admission. On multivariate regression analysis, after controlling for admission blood pressure, time to CT scan, and Marshall Score, age <55, GCS of 15 on arrival to the ICU, and isolated subarachnoid hemorrhage remained independent predictors of a favorable outcome. Patients meeting these criteria after mTBI with ICH likely do not require ICU-level care.

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Evaluation of Clinical Criteria for Performing Brain CT-Scan in Patients with Mild Traumatic Brain Injury; A New Diagnostic Probe

Bulletin of Emergency and Trauma ◽

10.29252/beat-070310 ◽

2019 ◽

Vol 7 (3) ◽

pp. 269-277

Author(s):

Roghieh Molaei-Langroudi ◽

Ahmad Alizadeh ◽

Ehsan Kazemnejad-Leili ◽

Vahid Monsef-Kasmaie ◽

Seyed-Younes Moshirian

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Clinical Criteria ◽

Brain Ct ◽

Diagnostic Probe ◽

Brain Ct Scan

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P048: Current practices of management for mild traumatic brain injuries with intracranial hemorrhage

CJEM ◽

10.1017/cem.2019.239 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S80

Author(s):

É. Fortier ◽

V. Paquet ◽

M. Émond ◽

J. Chauny ◽

S. Hegg ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Intracranial Hemorrhage ◽

Management Practices ◽

Brain Injuries ◽

Quebec City ◽

Historical Cohort ◽

Public Sector Health

Introduction: The radiological and clinical follow-up of patients with a mild traumatic brain injury (mTBI) and an intracranial hemorrhage (ICH) is often heterogeneous, as there is no official guideline for CT scan control. Furthermore, public sector health expenditure has increased significantly as the number of MRI and CT scan almost doubled in Canada in the last decade. Therefore, the main objective of this study was to describe the current management practices of mTBI patients with intracranial hemorrhage at two level-1 trauma centers. Methods: Design: An historical cohort was created at the CHU de Québec – Hôpital de l'Enfant-Jésus (Québec City) and Hôpital du Sacré-Coeur (Montréal). Consecutive medical records were reviewed from the end of 2017 backwards until sample saturation using a standardized checklist. Participants: mTBI patients aged ⩾16 with an ICH were included. Measures: The main and secondary outcomes were the presence of a control CT scan and neurosurgical consultation/admission. Analyses: Univariate descriptive analyses were performed. Inter-observer measures were calculated. Results: Two hundred seventy-four patients were included, of which 51.1% (n = 140) came from a transfer. Mean age was 60.8 and 68.9% (n = 188) were men. Repeat CT scan was performed in 73.6% (n = 201) of our patients as 12.5% showed a clinical deterioration. The following factors might have influenced clinician decision to proceed to a repeat scan: anticoagulation (association of 87.1% with scanning; n = 27), antiplatelet (84.1%; 58), GCS of 13 (94.1%; 16), GCS of 14 (75%; 72) and GCS of 15 (70.2%; 111). 93.0% (n = 254) of patients had a neurosurgical consultation and only 6.7% (17) underwent a neurosurgical intervention. Conclusion: The management of mild traumatic brain injury with hemorrhage uses a lot of resources that might be disproportionate with regards to risks. Further research to identify predictive factors of deterioration is needed.

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P17 Evaluation of new orleans criteria for cranial CT scan in mild traumatic brain injury at an emergency trauma unit of a developing country

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.95 ◽

2019 ◽

Vol 90 (3) ◽

pp. e30.2-e30

Author(s):

AS Yusuf ◽

MR Mahmud ◽

NK Dalhat ◽

AI Olayiwola ◽

JD Alfin ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

New Orleans ◽

Developing Country ◽

Mild Traumatic Brain Injury ◽

Compliance Rate ◽

Mild Tbi ◽

Cranial Ct ◽

Ct Findings

ObjectivesTo assess compliance to New Orleans Criteria for cranial CT scan and its predictive value for intracranial pathology in mild TBI.DesignA retrospective review.SubjectsAll patients with mild traumatic brain injury presenting at the emergency unit of a National Trauma Centre of a Developing Country over 24 months.MethodsPatients information were retrieved from medical record and entered into SPSS spreadsheet. The New Orleans Criteria (NOC) was used to determine indications for brain CT scan. Compliance to the criteria was determined. The CT scan findings were evaluated in all patients that had scan and the findings were compared between those met NOC and those who did not.ResultsOne-hundred and eighteen patients were studied. Majority were males 92 (82%) with mean age of 27 year. Most injuries (66.9%) resulted from road traffic crashes. Among 65 (55.1%) patients who met NOC only 41 (63.1%) had CT scan while 25 (47.2%) patients who did not had CT giving a compliance rate of 58.5%. Twenty three (56.1%) patients who met NOC had abnormal CT compared to 9 (36%) patients that did not. The most common abnormal CT findings in both groups were skull vault fractures (9 for NOC group and 2 for non NOC group) only two patients had surgical intervention and both met NOC criteria.ConclusionsThe compliance for NOC guideline was below average in our Centre. NOC guideline is useful in predicting abnormal CT findings. There is a need for continuous education of emergency physicians to ensure optimal CT scan utilisation in mild TBI.

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