Routine Repeat Head CT Does Not Change Management in Trauma Patients on Novel Anticoagulants

2020 ◽  
Vol 249 ◽  
pp. 114-120 ◽  
Author(s):  
Caitlin M. Cohan ◽  
Genna Beattie ◽  
Dana A. Dominguez ◽  
Melissa Glass ◽  
Barnard Palmer ◽  
...  
Keyword(s):  
Change Management ◽  
Trauma Patients ◽  
Head Ct ◽  
Novel Anticoagulants

scholarly journals Head CT Guidelines Following Concussion Among the Youngest Trauma Patients

2019 ◽  
Vol 11 (2) ◽  
pp. 38-43
Author(s):  
Bryan J. Harvell ◽  
Stephen D. Helmer ◽  
Jeanette G. Ward ◽  
Elizabeth Ablah ◽  
Raymond Grundmeyer ◽  
...  
Keyword(s):  
Skull Fracture ◽  
Pediatric Trauma ◽  
Altered Mental Status ◽  
Behavioral Changes ◽  
Neurosurgical Procedures ◽  
Trauma Patients ◽  
Clinical Indicators ◽  
Head Ct ◽  
Ct Findings ◽  
Basilar Skull Fracture

Introduction. Recent studies have provided guidelines on the use ofhead computed tomography (CT) scans in pediatric trauma patients.The purpose of this study was to identify the prevalence of theseguidelines among concussed pediatric patients. Methods. A retrospective review was conducted of patients fouryears or younger with a concussion from blunt trauma. Demographics,head injury characteristics, clinical indicators for head CT scan(severe mechanism, physical exam findings of basilar skull fracture,non-frontal scalp hematoma, Glasgow Coma Scale score, loss ofconsciousness, neurologic deficit, altered mental status, vomiting,headache, amnesia, irritability, behavioral changes, seizures, lethargy),CT results, and hospital course were collected. Results. One-hundred thirty-three patients (78.2%) received a headCT scan, 7 (5.3%) of which demonstrated fractures and/or bleeds. Allpatients with skull fractures and/or bleeds had at least one clinicalindicator present on arrival. Clinical indicators that were observedmore commonly in patients with positive CT findings than in thosewith negative CT findings included severe mechanism (100% vs.54.8%, respectively, p = 0.020) and signs of a basilar skull fracture(28.6% vs. 0.8%, respectively, p = 0.007). Severe mechanism alonewas found to be sensitive, but not specific, whereas signs of a basilarskull fracture, headache, behavioral changes, and vomiting were specific,but not sensitive. No neurosurgical procedures were necessary,and there were no deaths. Conclusions. Clinical indicators were present in patients with positiveand negative CT findings. However, severe mechanism of injuryand signs of basilar skull fracture were more common for patients withpositive CT findings. Kans J Med 2018;11(2):38-43.

scholarly journals Focused Assessment with Sonography in Trauma and Abdominal Computed Tomography Utilization in Adult Trauma Patients: Trends over the Last Decade

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Alexander Y. Sheng ◽  
Peregrine Dalziel ◽  
Andrew S. Liteplo ◽  
Peter Fagenholz ◽  
Vicki E. Noble
Keyword(s):  
Computed Tomography ◽  
Trauma Center ◽  
Trauma Registry ◽  
Imaging Modality ◽  
Point Of Care ◽  
Trauma Patients ◽  
Abdominal Ct ◽  
Head Ct ◽  
Ct Utilization ◽  
Over Time

Objective. We sought to describe the trend in abdominal CT use in adult trauma patients after a point-of-care emergency ultrasound program was introduced. We hypothesized that abdominal CT use would decrease as FAST use increased.Methods. We performed a retrospective study of 19940 consecutive trauma patients over the age of 18 admitted to our level one trauma center from 2002 through 2011. Data was collected retrospectively and recorded in a trauma registry. We plotted the rate of FAST and abdominal CT utilization over time. Head CT was used as a surrogate for overall CT utilization rates during the study period.Results. Use of FAST increased by an average of 2.3% (95% CI 2.1 to 2.5,P<0.01) while abdominal CT use decreased by the same rate annually. The percentage of patients who received FAST as the sole imaging modality for the abdomen rose from 2.0% to 21.9% while those who only received an abdominal CT dropped from 21.7% to 2.3%.Conclusions. Abdominal CT use in our cohort declined while FAST utilization grew in the last decade. The rising use of FAST may have played a role in the reduction of abdominal CT performed as decline in CT utilization appears contrary to overall trends.

scholarly journals Less Is More? The Impact of Trauma Volume on the Positive Rate of Head Computed Tomography Scans in Head Trauma Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-6
Author(s):  
Chao-Wen Chen ◽  
Yun-Ting Lou ◽  
Chi-Ming Chu ◽  
Hsing-Lin Lin ◽  
Wei-Che Lee ◽  
...  
Keyword(s):  
Head Trauma ◽  
Tertiary Care ◽  
Ct Scans ◽  
Trauma Patients ◽  
Care Hospital ◽  
Head Ct ◽  
Computed Tomography Scans ◽  
Positive Rate ◽  
The Impact ◽  
Head Computed Tomography

Objective. Few studies have assessed the impact of trauma volume on the operational efficiency of emergency departments. Herein, we evaluate the association between trauma volume with the positive rate of head computed tomography scans in head trauma patients in a tertiary care hospital.Methods. This is a retrospective cohort review involving all head trauma patients presenting to a tertiary care hospital. Trauma census, head trauma patient volume, the number of emergent head CT scans, and the number of positive head CT scans were collected on a monthly basis. Comparison was primarily made between the trauma patient volume and the positive rate of head CT scans.Results. 25,549 trauma patients were reviewed. Of these, 5,168 (20.2%) sustained head trauma and 3,336 head CT scans were performed with mean 29.1% positive rate of substantial head injuries. The monthly data were analyzed and a statistically significant correlation between monthly trauma volume and decrease in positive rate of head CT scan was identified (Pearsonr=−0.51,P=0.02). With introducing different cut-point values of trauma volume, we identified the threshold of trauma census as approximately 4.9 and 8.8% higher than mean monthly trauma volume in discriminating significant decrease of positive rate of head CT scans.

Acute Traumatic Intraparenchymal Hemorrhage: Risk Factors for Progression in the Early Post-injury Period

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. 647-656 ◽  
Author(s):  
Edward F. Chang ◽  
Michele Meeker ◽  
Martin C. Holland
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Ct Scan ◽  
Subdural Hematoma ◽  
Outcome Variable ◽  
Trauma Patients ◽  
Post Injury ◽  
Initial Size ◽  
Head Ct ◽  
Surgical Evacuation

Abstract OBJECTIVE: To characterize the natural course of traumatic intraparenchymal contusions and hematomas (IPHs) and to identify risk factors for IPH progression in the acute post-injury period. METHODS: A retrospective analysis was performed on a prospective observational database containing 113 head trauma patients exhibiting 229 initially nonoperated acute IPHs. The main outcome variable was radiographic evidence of IPH progression on serially obtained head computed tomographic (CT) scans. Secondary outcomes included the actual amount of IPH growth and later surgical evacuation. Univariate and multivariate analyses (using a generalized estimate equation) were applied to both demographic and initial radiographic features to identify risk factors for IPH progression and surgery. RESULTS: Overall, 10 IPHs (4%) shrank, 133 (58%) remained unchanged, and 86 (38%) grew between the first and second head CT scan. IPH progression was independently associated with the presence of subarachnoid hemorrhage (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.12–2.3), presence of a subdural hematoma (OR, 1.94; 95% CI, 1.1–3.43), and initial size (OR, 1.11; 95% CI, 1.02–1.21, for each cm3 volume). Size of initial IPH proportionately correlated with the amount of subsequent growth (linear regression, P &lt; 0.001). Worsened Glasgow Coma Score between initial and follow-up head CT scan (OR, 8.6; 95% CI, 1.5–50), IPH growth greater than 5 cm3 (OR, 7.3; 95% CI, 1.6–34), and effacement of basal cisterns on initial CT scan (OR, 9.0; 95% CI, 1.5–52) were strongly associated with late surgical evacuation. CONCLUSION: A large proportion of IPHs progress in the acute post-injury period. IPHs associated with subarachnoid hemorrhage, a subdural hematoma, or large initial size should be monitored carefully for progression with repeat head CT imaging. Effacement of cisterns on the initial head CT scan was strongly predictive of failure of nonoperative management, thereby leading to surgical evacuation. These findings should be important factors in the understanding and management of IPH.

Worsening head bleeds in elderly blunt head trauma patients taking antithrombotics: Delayed CT head fails to change management

Injury ◽  
2019 ◽  
Vol 50 (1) ◽  
pp. 54-60 ◽  
Author(s):  
Dane Scantling ◽  
Robert Kucejko ◽  
John Williamson ◽  
Alvaro Galvez ◽  
Amanda Teichman ◽  
...  
Keyword(s):  
Change Management ◽  
Head Trauma ◽  
Trauma Patients ◽  
Blunt Head Trauma ◽  
Ct Head

scholarly journals Diagnostic Yield and Outcomes of Computed Tomography of the Head in Critically Ill Nontrauma Patients

2017 ◽  
Vol 34 (11-12) ◽  
pp. 955-966
Author(s):  
Fabian Finkelmeier ◽  
Sophie Walter ◽  
Kai-Henrik Peiffer ◽  
Anjali Cremer ◽  
Andrea Tal ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Independent Predictor ◽  
Diagnostic Yield ◽  
Pathological Finding ◽  
Trauma Patients ◽  
Head Ct ◽  
Therapeutic Consequences ◽  
Altered Mental State ◽  
New Finding

Background: Computed tomography of the head (HCT) is a widely used diagnostic tool, especially for emergency and trauma patients. However, the diagnostic yield and outcomes of HCT for patients on medical intensive care units (MICUs) are largely unknown. Methods: We retrospectively evaluated all head CTs from patients admitted to a single-center MICU during a 5-year period for CT indications, diagnostic yield, and therapeutic consequences. Uni- and multivariate analyses for the evaluation of risk factors for positive head CT were conducted. Results: Six hundred ninety (18.8%) of all patients during a 5-year period underwent HCT; 78.7% had negative CT results, while 21.3% of all patients had at least 1 new pathological finding. The main indication for acquiring CT scan of the head was an altered mental state (AMS) in 23.5%, followed by a new focal neurology in 20.7% and an inadequate wake up after stopping sedation in 14.9% of all patients. The most common new finding was intracerebral bleeding in 6.4%. In 6.7%, the CT scan itself led to a change of therapy of any kind. Admission after resuscitation or a new focal neurology were independent predictors of a positive CT. Psychic alteration and AMS were both independent predictors of a higher chance of a negative head CT. Positive HCT during MICU is an independent predictor of lower survival. Conclusions: New onset of focal neurologic deficit seems to be a good predictor for a positive CT, while AMS and psychic alterations seem to be very poor predictors. A positive head CT is an independent predictor of death for MICU patients.

scholarly journals Evaluation of Concomitant Orbital Floor Fractures in Patients with Head Trauma Using Conventional Head CT Scan: A Retrospective Study at a Level II Trauma Center

2019 ◽  
Vol 8 (11) ◽  
pp. 1852 ◽  
Author(s):  
Li-Kuo Huang ◽  
Hsi-Feng Tu ◽  
Liang-De Jiang ◽  
Ying-Yuan Chen ◽  
Chih-Yuan Fu
Keyword(s):  
Head Trauma ◽  
Predictive Value ◽  
Orbital Floor ◽  
Trauma Patients ◽  
Head Ct ◽  
High Attenuation ◽  
Ct Findings ◽  
Level Ii ◽  
Orbital Floor Fractures ◽  
High Negative Predictive Value

Background: Patients with head trauma may have concomitant orbital floor fractures (OFFs). The objective of our study was to determine the specific CT findings and investigate the diagnostic performance of head CT in detecting OFFs. Methods: We analyzed 3534 head trauma patients undergoing simultaneous head and facial CT over a 3-year period. The clinical data and specific head CT findings between patients with and without OFFs were compared. Results: In our cohort, 198 patients (5.6%) had OFFs visible on CT. On head CT, orbital floor discontinuity, gas bubbles entrapped between floor fragments, inferior extraconal emphysema, and maxillary hemosinus (MHS) were more commonly observed among patients with OFFs (p < 0.001). The absence of MHS had a high negative predictive value (99.7%) for excluding OFFs. Among the different types of MHS, the pattern showing high-attenuation opacity mixed with mottled gas had the highest positive predictive value (69.5%) for OFFs and was the only independent predictor of OFFs after adjusting for the other CT variables in all patients with MHS. Conclusion: Head CT may serve as a first-line screening tool to detect OFFs in head trauma patients. Hence, unnecessary facial CT and additional radiation exposure may be reduced.

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