Limited benefit of systematic head CT for mild traumatic brain injury in patients under antithrombotic therapy

2021 ◽  
Author(s):  
Lucie Colas ◽  
Sahara Graf ◽  
Juliette Ding ◽  
Gregory Bertolotti ◽  
Nicolas Thellier ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Antithrombotic Therapy ◽  
Head Ct

scholarly journals Head CT overuse in children with a mild traumatic brain injury within two Canadian emergency departments

2019 ◽  
Vol 25 (1) ◽  
pp. 26-32
Author(s):  
Martin Gariepy ◽  
Jocelyn Gravel ◽  
France Légaré ◽  
Edward R Melnick ◽  
Erik P Hess ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Emergency Departments ◽  
Retrospective Chart Review ◽  
Trauma Centre ◽  
Diagnostic Tools ◽  
General Level ◽  
Head Ct ◽  
Significant Difference

Abstract Background The validated Pediatric Emergency Care Applied Network (PECARN) rule helps determine the relevance of a head computerized tomography (CT) for children with mild traumatic brain injury (mTBI). We sought to estimate the potential overuse of head CT within two Canadian emergency departments (EDs). Methods We conducted a retrospective chart review of children seen in 2016 in a paediatric Level I (site 1) and a general Level II (site 2) trauma centre. We reviewed charts to determine the appropriateness of head CT use according to the PECARN rule in a random subset of children presenting with head trauma. Simple descriptive statistics were applied. Results One thousand five hundred and forty-six eligible patients younger than 17 years consulted during the study period. Of the 203 randomly selected cases per setting, 16 (7.9%) and 24 (12%), respectively from sites 1 and 2 had a head CT performed. Based on the PECARN rule, we estimated the overuse for the younger group (<2 years) to be below 3% for both hospitals without significant difference between them. For the older group (≥2 years), the overuse rate was higher at site 2 (9.3%, 95% confidence interval [CI]: 4.8 to 17% versus 1.2%, 95% CI: 0.2 to 6.5%, P=0.03). Conclusion Both EDs demonstrated overuse rates below 10% although it was higher for the older group at site 2. Such low rates can potentially be explained by the university affiliation of both hospitals and by two Canadian organizations working to raise awareness among physicians about the overuse of diagnostic tools and dangers inherent to radiation.

scholarly journals Clinical Predictors of 3- and 6-Month Outcome for Mild Traumatic Brain Injury Patients with a Negative Head CT Scan in the Emergency Department: A TRACK-TBI Pilot Study

2020 ◽  
Vol 10 (5) ◽  
pp. 269
Author(s):  
Debbie Madhok ◽  
John Yue ◽  
Xiaoying Sun ◽  
Catherine Suen ◽  
Nathan Coss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Pilot Study ◽  
Mild Traumatic Brain Injury ◽  
Psychiatric History ◽  
Clinical Predictors ◽  
Head Ct ◽  
Risk Patients

A considerable subset of mild traumatic brain injury (mTBI) patients fail to return to baseline functional status at or beyond 3 months postinjury. Identifying at-risk patients for poor outcome in the emergency department (ED) may improve surveillance strategies and referral to care. Subjects with mTBI (Glasgow Coma Scale 13–15) and negative ED initial head CT < 24 h of injury, completing 3- or 6-month functional outcome (Glasgow Outcome Scale-Extended; GOSE), were extracted from the prospective, multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study. Outcomes were dichotomized to full recovery (GOSE = 8) vs. functional deficits (GOSE < 8). Univariate predictors with p < 0.10 were considered for multivariable regression. Adjusted odds ratios (AOR) were reported for outcome predictors. Significance was assessed at p < 0.05. Subjects who completed GOSE at 3- and 6-month were 211 (GOSE < 8: 60%) and 185 (GOSE < 8: 65%). Risk factors for 6-month GOSE < 8 included less education (AOR = 0.85 per-year increase, 95% CI: (0.74–0.98)), prior psychiatric history (AOR = 3.75 (1.73–8.12)), Asian/minority race (American Indian/Alaskan/Hawaiian/Pacific Islander) (AOR = 23.99 (2.93–196.84)), and Hispanic ethnicity (AOR = 3.48 (1.29–9.37)). Risk factors for 3-month GOSE < 8 were similar with the addition of injury by assault predicting poorer outcome (AOR = 3.53 (1.17–10.63)). In mTBI patients seen in urban trauma center EDs with negative CT, education, injury by assault, Asian/minority race, and prior psychiatric history emerged as risk factors for prolonged disability.

Repeat head CT in mild traumatic brain injury is really necessary?

2020 ◽  
Vol 38 (2) ◽  
pp. 393-394
Author(s):  
Alba Scerrati ◽  
Gianluca Trevisi ◽  
Pasquale De Bonis ◽  
Annunziato Mangiola
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Head Ct

scholarly journals 1554: UTILITY OF REPEAT HEAD CT ON MILD TRAUMATIC BRAIN INJURY PATIENTS

2021 ◽  
Vol 50 (1) ◽  
pp. 781-781
Author(s):  
Candace Ward ◽  
Ryan Cohen ◽  
Samantha Olafson ◽  
Austin Goetz ◽  
Pak Shan Leung ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Head Ct

Persistent postconcussive symptoms in children and adolescents with mild traumatic brain injury receiving initial head computed tomography

2021 ◽  
pp. 1-10
Author(s):  
Lennart Riemann ◽  
Daphne C. Voormolen ◽  
Katrin Rauen ◽  
Klaus Zweckberger ◽  
Andreas Unterberg ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Young Patients ◽  
High Energy ◽  
Ct Imaging ◽  
Head Ct ◽  
Postconcussive Symptoms

OBJECTIVEThe aim of this paper was to evaluate the prevalence of postconcussive symptoms and their relation to health-related quality of life (HRQOL) in pediatric and adolescent patients with mild traumatic brain injury (mTBI) who received head CT imaging during initial assessment.METHODSPatients aged between 5 and 21 years with mTBI (Glasgow Coma Scale scores 13–15) and available Rivermead Post Concussion Questionnaire (RPQ) at 6 months of follow-up in the multicenter, prospectively collected CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) study were included. The prevalence of postconcussive symptoms was assessed, and the occurrence of postconcussive syndrome (PSC) based on the ICD-10 criteria, was analyzed. HRQOL was compared in patients with and without PCS using the Quality of Life after Brain Injury (QOLIBRI) questionnaire.RESULTSA total of 196 adolescent or pediatric mTBI patients requiring head CT imaging were included. High-energy trauma was prevalent in more than half of cases (54%), abnormalities on head CT scans were detected in 41%, and admission to the regular ward or intensive care unit was necessary in 78%. Six months postinjury, 36% of included patients had experienced at least one moderate or severe symptom on the RPQ. PCS was present in 13% of adolescents and children when considering symptoms of at least moderate severity, and those patients had significantly lower QOLIBRI total scores, indicating lower HRQOL, compared with young patients without PCS (57 vs 83 points, p < 0.001).CONCLUSIONSAdolescent and pediatric mTBI patients requiring head CT imaging show signs of increased trauma severity. Postconcussive symptoms are present in up to one-third of those patients, and PCS can be diagnosed in 13% 6 months after injury. Moreover, PCS is significantly associated with decreased HRQOL.

Does head CT scan pathology predict outcome after mild traumatic brain injury?

2012 ◽  
Vol 20 (1) ◽  
pp. 124-129 ◽  
Author(s):  
M. Lannsjö ◽  
M. Backheden ◽  
U. Johansson ◽  
J. L. af Geijerstam ◽  
J. Borg
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Head Ct

S100B outperforms clinical decision rules for the identification of intracranial injury on head CT scan after mild traumatic brain injury

Brain Injury ◽  
2020 ◽  
Vol 34 (3) ◽  
pp. 407-414 ◽  
Author(s):  
Courtney Marie Cora Jones ◽  
Christopher Harmon ◽  
Molly McCann ◽  
Holly Gunyan ◽  
Jeffrey J. Bazarian
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Decision Rules ◽  
Clinical Decision ◽  
Intracranial Injury ◽  
Clinical Decision Rules ◽  
Head Ct

Utility of routine follow-up head CT scanning after mild traumatic brain injury: a systematic review of the literature

2012 ◽  
Vol 29 (7) ◽  
pp. 528-532 ◽  
Author(s):  
Martina Stippler ◽  
Carl Smith ◽  
A Robb McLean ◽  
Andrew Carlson ◽  
Sarah Morley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Ct Scanning ◽  
Review Of The Literature ◽  
Head Ct
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