Is Repeated Head Computed Tomography Necessary for Traumatic Intracranial Hemorrhage?

2005 ◽  
Vol 71 (9) ◽  
pp. 701-704 ◽  
Author(s):  
Rob Schuster ◽  
Kenneth Waxman
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Multivariate Analysis ◽  
Intracranial Hemorrhage ◽  
Trauma Center ◽  
Head Ct ◽  
Neurologic Status ◽  
Level Ii ◽  
Traumatic Intracranial Hemorrhage ◽  
Head Computed Tomography

This study was performed to determine the need for repeat head computed tomography (CT) in patients with blunt traumatic intracranial hemorrhage (ICH) who were initially treated nonoperatively and to determine which factors predicted observation failure or success. A total of 1,462 patients were admitted to our level II trauma center for treatment of head injury. Seventeen per cent (255/1,462) were diagnosed with ICH on initial head CT. Craniotomy was initially performed in 15.7 per cent (40/255) of patients with ICH. Two hundred sixteen patients with ICH were initially observed. Ninety-seven per cent (179/184) of observed patients with ICH and repeat head CT never underwent a craniotomy, 2.7 per cent (5/184) of patients with ICH initially observed underwent craniotomy after repeat head CT, and four patients (80%) had deteriorating neurologic status. Multivariate analysis revealed the following significant admission risk factors were associated with a need for repeat head CT indicating the need for craniotomy: treatment with anti-coagulation and/or antiplatelet medications, elevated prothrombin time (PT), and age greater than 70 years. In patients with blunt traumatic intracranial hemorrhage initially observed, there is little utility of repeated head CT in the absence of deteriorating neurologic status. The only admission risk factors for a repeat CT indicating the need for craniotomy were advanced age and coagulopathy.

Repeat Head CT? Not Necessary for Patients with a Negative Initial Head CT on Anticoagulation or Antiplatelet Therapy Suffering Low-Altitude Falls

2017 ◽  
Vol 83 (5) ◽  
pp. 429-435 ◽  
Author(s):  
Zachary M. Bauman ◽  
John M. Ruggero ◽  
Sunny Squindo ◽  
Chris Mceachin ◽  
Michelle Jaskot ◽  
...  
Keyword(s):  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Trauma Center ◽  
Statistical Significance ◽  
Close Monitoring ◽  
Trauma Centers ◽  
Head Ct ◽  
Level Ii ◽  
Low Altitude ◽  
Related Mortality

Anticoagulation and antiplatelet (ACAP) medications are increasingly prescribed to patients at high risk for falls. Many trauma centers have developed protocols for obtaining repeat head CT (HCT) for patients with low-altitude falls on ACAP therapy. We assess the need for routine scheduled repeat HCT in this population. Prospective, observational analysis of all low-altitude fall (<6 feet) patients on ACAP therapy evaluated at a Level II trauma center. All low-altitude fall patients with visible or suspected head trauma received an initial HCT. Patients were admitted and repeat HCT was obtained 12 hours later or earlier if acute neurologic decline developed. Chisquared, Fischer exact, t, and Wilcoxon rank-sum tests were used. Statistical significance was defined as P < 0.05. Total of 1501 patients enrolled suffering low-altitude falls with initial HCT. Among them 1379(91.2%) were negative and 122(8.1%) were initially positive for intracranial hemorrhage. Mean age was 79.9 ± 11.4 years, 61 per cent were female and 85 per cent had visible head trauma at presentation. One hundred ninety-nine were excluded secondary to not receiving repeat HCT. Of the 1180 patients with normal initial HCT who underwent repeat HCT, only 7 (0.51%) had delayed intracranial hemorrhage. None of these patients required surgery, major changes in medical management or suffered head trauma–related mortality; 69 per cent were taking aspirin (acetylsalicylic acid, ASA), 19 per cent warfarin, 17 per cent clopidogrel, 6 per cent other anticoagulants, and 11 per cent were on combination therapy. Repeat HCT for patients on any ACAP therapy after low-altitude fall with a negative initial HCT is not necessary. Thorough neurologic examination and close monitoring is as effective as obtaining a repeat HCT.

Repeat Head Computed Tomography in Anticoagulated Traumatic Brain Injury Patients: Still Warranted

2014 ◽  
Vol 80 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Bellal Joseph ◽  
Moutamn Sadoun ◽  
Hassan Aziz ◽  
Andrew Tang ◽  
Julie L. Wynne ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Intracranial Hemorrhage ◽  
Injury Severity ◽  
Head Ct ◽  
Lengths Of Stay ◽  
Anticoagulation Agents ◽  
Head Computed Tomography

Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CT with prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neuro-surgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using χ2 and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older ( P < 0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission ( P < 0.001), were more likely to present with an abnormal neurologic examination ( P = 0.004), and had higher hospital and intensive care unit lengths of stay ( P < 0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P < 0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information.

scholarly journals Pattern of Emergent Head Computed Tomography Findings in a Tertiary Care Hospital during off Working Hours: Retrospective Analysis

2019 ◽  
Vol 10 (02) ◽  
pp. 207-211
Author(s):  
Rajneesh K. Patel ◽  
Amit Kumar Choubey ◽  
Brijesh K. Soni ◽  
Rajeev Sivasankar ◽  
Vikash Chauhan
Keyword(s):  
Computed Tomography ◽  
Health Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Working Hours ◽  
Care Hospital ◽  
Head Ct ◽  
Total Head ◽  
Ct Head ◽  
Head Computed Tomography

ABSTRACT Introduction: Emergency head computed tomography (CT) is rising exponentially during off working hours due to evidence-based medicine, patient’s expectation and desires, easy availability and apprehension of medico-legal cases, thereby raising health-care cost. There is huge gap in demand and supply of radiologist, especially during off working hours. There is need to know the pattern of emergency head findings. Materials and Methods: A retrospective analysis of all emergent noncontrast CT head during off working hours in the Department of Radiodiagnosis of a Tertiary Care Hospital, Mumbai, India, which were performed from June 2017 to May 2018. CT findings of 308 patients were analyzed. Results: About 63.6% of total head CT showed no significant abnormality. The most common abnormality was intracranial hemorrhage which was just 9.1% followed by acute infarct which was 6.2%. Extradural hemorrhage, subdural hemorrhage, and subarachnoid hemorrhage was only 1% each of total head CT findings. No significant abnormality was detected in 74.65%, 70.21%, 89.13%, 31.37%, 100%, and 69.09% in cases of head injury, seizure, giddiness/dizziness/syncope, cerebrovascular accident, transient ischemic attack, and altered sensorium, respectively. Conclusion: Pattern analysis of emergent head CT reveals that most of the emergent CT head shows no significant abnormality. There is a need for stringent guidelines for emergent head CT, training of emergency physician as well as CT technician for common findings to bridge the radiologist demand-supply gap for providing effective health care in peripheral hospitals.

Correlation Between Anterior–Posterior and Lateral Dimensions with the Effective and Water-Equivalent Diameters in Axial Images From Head Computed Tomography Examinations

2021 ◽  
Author(s):  
Winda Kusuma Dewi ◽  
Choirul Anam ◽  
Eko Hidayanto ◽  
Annisa Lidia Wati ◽  
Geoff Dougherty
Keyword(s):  
Computed Tomography ◽  
Linear Correlation ◽  
Second Order ◽  
Patient Dose ◽  
Equivalent Diameter ◽  
Effective Diameter ◽  
Head Ct ◽  
Order Polynomial ◽  
Head Computed Tomography ◽  
Anterior Posterior

Abstract The study aims to correlate the effective diameter (Deff) and water-equivalent diameter (Dw) parameters with anterior–posterior (AP), lateral (LAT) and AP + LAT dimensions in order to estimate the patient dose in head CT examinations. Seventy-four patient datasets from head CT examinations were retrospectively collected. The patient’s sizes were calculated from the middle slice using a software of IndoseCT. Dw and Deff were plotted as functions of AP, LAT and AP + LAT dimensions. The best trendline fit for LAT and AP functions was a second order polynomial, which resulted in R2 of 0.89 for Deff vs LAT, 0.88 for Dw vs LAT, 0.92 for Deff vs AP and 0.91 for Dw vs AP. A linear correlation was found for Deff vs AP + LAT, Dw vs AP + LAT and Dw vs Deff with R2 of 0.97, 0.96 and 0.98, respectively.

A PHANTOM STUDY SHOWING THE IMPORTANCE OF BREAST SHIELDING DURING HEAD CT

2020 ◽  
Vol 188 (4) ◽  
pp. 464-469 ◽  
Author(s):  
Nika Zalokar ◽  
Nejc Mekiš
Keyword(s):  
Computed Tomography ◽  
Dose Reduction ◽  
Phantom Study ◽  
Anthropomorphic Phantom ◽  
Head Ct ◽  
Lead Shield ◽  
Phantom Measurements ◽  
Lead Shielding ◽  
Head Computed Tomography

Abstract This study aimed to investigate the dose to the breasts during head computed tomography (CT) if lead shielding is used. The study was performed in two major hospitals using helical and axial protocols on an anthropomorphic phantom. Measurements were performed with and without the use of a lead shield of 0.5 mm equivalent density. The results showed a significant decrease in dose with the lead shielding in both hospitals. During the helical protocol, the use of shielding significantly reduced the dose by 96% in Hospital A and 82% in Hospital B. The dose reduction during axial protocol was also significant: 95% in Hospital A and 86% in Hospital B with lead shielding. Considering the significant dose reduction of 82% up to 96% during this study, we highly recommend the shielding of breasts regardless of the protocol used during head CT examinations.

Utility of Repeat Head Computed Tomography for Intracranial Hemorrhage After Trauma and Importance of Direct Patient Care

2016 ◽  
Vol 23 (5) ◽  
pp. 304-306
Author(s):  
Mary Ellen Zimmermann ◽  
Zachary Brown ◽  
Praise Matemavi ◽  
Gloria Melnic ◽  
Jason Sample
Keyword(s):  
Computed Tomography ◽  
Patient Care ◽  
Intracranial Hemorrhage ◽  
Direct Patient Care ◽  
Head Computed Tomography

Abstract 375: Utility of Routine Early Head Computed Tomography Following Non-Traumatic Out-Of Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Bradley J Petek ◽  
David E Hamilton ◽  
Lindsay G Panah ◽  
Philip E Dormish ◽  
Sean R Mendez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Clinical Utility ◽  
Spontaneous Circulation ◽  
Head Ct ◽  
Shockable Rhythm ◽  
Baseline Characteristics ◽  
Poor Outcomes ◽  
Head Computed Tomography ◽  
Hospital Cardiac Arrest

Introduction: Head computed tomography (CT) is frequently performed in survivors of out-of-hospital cardiac arrest (OHCA). However, the clinical utility of routine, early head CT in these patients is not well understood. We sought to characterize the associations between findings on early head CT with presenting characteristics and outcomes in survivors of OHCA. Hypothesis: Presence of early intracranial swelling is associated with poor outcomes. Methods: This is a retrospective analysis from a multicenter cohort of 432 patients with non-traumatic OHCA between 2/1/17 through 4/1/19. Patients were included if they underwent head CT <24 hrs after return of spontaneous circulation. Head CT findings were based on reads performed by local radiologists. Intracranial swelling was defined as loss of gray-white matter differentiation, sulcal effacement, and/or cerebral edema. Underlying cause of OHCA was adjudicated by trained physicians. Baseline characteristics and outcomes were compared between those with and without intracranial swelling. Result: Early head CT (<24 hrs) was performed in 378 (87.5%) patients with OHCA. Intracranial swelling was present in 97 (25.7%) patients with early head CT, and 14 (3.7%) had evidence of intracranial hemorrhage (ICH, Table). Of the patients presenting with ICH, 3/14 (21.4%) had shockable rhythms, 7/14 (50%) had subarachnoid hemorrhage, and ICH was the adjudicated cause of arrest in 10/14 (71.4%) patients. Patients with intracranial swelling were younger, less likely to have presented with a shockable rhythm, cardiac etiology, and witnessed OHCA. They were more likely to have a suppressed EEG, anoxia on MRI, and were less likely to survive to hospital discharge. Conclusions: In survivors of non-traumatic OHCA, routine, early (<24 hrs) head CT identified ICH in 3.7% of patients, and ICH was the adjudicated cause of arrest in 2.6% of patients. Intracranial swelling was present in more than 1/4 of patients, and associated with poor outcomes.

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