scholarly journals Clinical Indications of Computed Tomography (CT) of the Head in Patients With Low-Energy Geriatric Hip Fractures: A Follow-Up Study at a Community Hospital

2019 ◽  
Vol 10 ◽  
pp. 215145931986156
Author(s):  
Kris Danielson ◽  
Teresa Hall ◽  
Terrence Endres ◽  
Clifford Jones ◽  
Deb Sietsema
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Low Energy ◽  
Ct Scans ◽  
Head Ct ◽  
Clinical Variables ◽  
Femur Fractures ◽  
Neurosurgical Intervention

Introduction: A seemingly large percentage of geriatric patients with isolated low-energy femur fractures undergo a head computed tomography (CT) scans during initial work up in the emergency department. This study aimed to evaluate the pertinent clinical variables that are associated with positive CT findings with the objective to decrease the number of unnecessary CT scans performed. Methods: A retrospective review performed at a level II trauma center including 713 patients over the age of 65 sustaining a femur fracture following a low-energy fall. The main outcome measure was pertinent clinical variables that are associated with CT scans that yielded positive findings. Results: A total of 713 patients over the age of 65 were included, with a low-energy fall, of which 76.2% (543/713) underwent a head CT scan as part of their evaluation. The most common presenting symptom reported was the patient hitting their head, 13% (93/713), and 1.8% (13/713) were unsure if they had hit their head. Of those evaluated with a head CT scan, only 3 (0.4%) had acute findings and none required acute neurosurgical intervention. All three patients with acute changes on the head CT scan had an Injury Severity Score (ISS) greater than 9, Glasgow Coma Scale (GCS) less than 15, and evidence of trauma above the clavicles. Discussion: None of the patients with a traumatic injury required a neurosurgical intervention after sustaining a low-energy fall (0/713). Conclusion: Head CT scans should have a limited role in the workup of this patient population and should be reserved for patients with a history and physical exam findings that support head trauma, an ISS > 9 and GCS < 15.

Repeat Computed Tomography for Trauma Patients Undergoing Transfer to a Level I Trauma Center

2012 ◽  
Vol 78 (6) ◽  
pp. 675-678 ◽  
Author(s):  
Andrew Joseph Young ◽  
Kenneth Sadlermeyers ◽  
Luke Wolfe ◽  
Therese Marieduane
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Injury Severity ◽  
Trauma Registry ◽  
Injured Patient ◽  
Ct Scans ◽  
Trauma Patients ◽  
Lengths Of Stay ◽  
Level I ◽  
Repeat Imaging

Our goal was to determine the characteristics of trauma transfer patients with repeat imaging. A retrospective trauma registry review was performed to evaluate trauma patients who were transferred from referring institutions between January 2005 and December 2009. Patients were divided into those who had a duplicate computed tomography (CT) scan versus those who did not. There were 2678 patients included of whom 559 (21%) had at least one repeat CT scan, whereas 2119 (79%) did not have any repeat CT scans. Those with repeat CT scans were older (42.3 ± 27.3 years vs 37.3 ± 25.6 years), had a higher Injury Severity Score (ISS) (13.7 ± 8.7 vs 11.9 ± 8.8), and more likely to have blunt trauma (odds ratio, 4.7; confidence interval, 2.3 to 9.6) (P for all < 0.0007). Those with CT scans done only at the referring facility were younger, had a lower ISS, and shorter lengths of stay (P for all < 0.0003). ISS and age were independent predictors for repeat CT scans. Transfer patients had imaging repeated one-fifth of the time. The younger, less injured patient went without repeat imaging suggesting that they may have been adequately cared for at the outside institution.

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.

Utility of Neurosurgical Consultation for Mild Traumatic Brain Injury

2006 ◽  
Vol 72 (12) ◽  
pp. 1162-1167 ◽  
Author(s):  
Toan Huynh ◽  
David G. Jacobs ◽  
Stephanie Dix ◽  
Ronald F. Sing ◽  
William S. Miles ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Ct Scans ◽  
Trauma Patients ◽  
Head Ct ◽  
Abnormal Head ◽  
The Mean ◽  
Gcs Score ◽  
Neurosurgical Intervention

Trauma patients presenting with a Glasgow Coma Scale (GCS) score of 14–15 are considered to have mild traumatic brain injury (TBI) with overall good neurologic outcomes. Current practice consists of initial stabilization, followed by a head CT, and neurosurgical consultation. Aside from serial neurologic examinations, patients with a GCS of 15 rarely require neurosurgical intervention. In this study, we examined the added value of neurosurgical consultation in the care of patients after TBI with a GCS of 15. We retrospectively reviewed the medical records of patients presenting after blunt trauma with an abnormal head CT and GCS of 15 between January 2004 and January 2005. Patients with a normal head CT and <48 hours hospital stay were excluded. Data included demographics, mechanisms of injury, Injury Severity Score, the radiologists’ dictated interpretations of the head CT, and neurosurgical interventions. Fifty-six patients met the inclusion criteria. The mean age was 41 ± 2.3 years, and the mean Injury Severity Scores was 10.2 ± 0.6. Mechanisms of injury included 64 per cent motor vehicle crash, 16 per cent motorcycle crash, 13 per cent fall, and 7 per cent all-terrain vehicle crash. The initial CT scans showed 43 per cent parenchymal contusions, 38 per cent subarachnoid hemorrhage, 14 per cent subdural hematomas, and 5 per cent epidural hematomas. All patients received a routine follow-up head CT, and 16 per cent showed changes (five improved and four were worse compared with initial CT scans). None of these patients received a neurosurgical intervention, and two were transferred to a rehabilitation service. In this era of limited resources, trauma patients who present with a GCS score of 15 after mild TBI can be safely managed without neurosurgical consultation, even in the presence of an abnormal head CT scan.

scholarly journals Role of repeat CT in mild to moderate head injury: an institutional study

2019 ◽  
Vol 47 (5) ◽  
pp. E2 ◽  
Author(s):  
Madhusudhan Nagesh ◽  
Kautilya Rajendrakumar Patel ◽  
Ajit Mishra ◽  
Ujwal Yeole ◽  
Andiperumal R. Prabhuraj ◽  
...  
Keyword(s):  
Head Injury ◽  
Ct Scan ◽  
Neurological Deterioration ◽  
Ct Scans ◽  
Midline Shift ◽  
Head Ct ◽  
Gcs Score ◽  
Neurosurgical Intervention ◽  
Basal Cisterns

OBJECTIVEPatients with traumatic brain injury (TBI) often undergo repeat head CT scans to identify the possible progression of injury. The objective of this study is to evaluate the need for routine repeat head CT scans in patients with mild to moderate head injury and an initial positive abnormal CT scan.METHODSThis is a retrospective study of patients presenting to the emergency department from January 2016 to December 2017 with Glasgow Coma Scale (GCS) scores > 8 and an initial abnormal CT scan, who underwent repeat CT during their in-hospital medical management. Patients who underwent surgery after the first CT scan, had a GCS score < 9, or had a normal initial CT scan were excluded. Demographic, medical history, and physical examination details were collected, and CT scans were reviewed. Radiological deterioration, neurological deterioration, and/or the need for neurosurgical intervention were the primary outcome variables.RESULTSA total of 1033 patients were included in this study. These patients underwent at least two CT scans on an inpatient basis. Of these 1033 patients, 54.1% had mild head injury and 45.9% had moderate head injury based on GCS score at admission. The most common diagnosis was contusion (43.8%), followed by extradural hematoma (28.8%) and subdural hematoma (26.6%). A total of 2636 CT scans were performed for 1033 patients, with a mean of 2.55 per patient. Of these, 25 (2.4%) had neurological deterioration, 90 (8.7%) had a progression of an existing lesion or appearance of a new lesion on repeat CT, and 101 (9.8%) required neurosurgical intervention. Seventy-five patients underwent surgery due to worsening of repeat CT without neurological deterioration, so the average number of repeat CT scans required to identify one such patient was 21.3. On multiple logistic regression, GCS score at admission (p = 0.024), abnormal international normalized ratio (INR; p < 0.001), midline shift (p = 0.005), effaced basal cisterns (p < 0.001), and multiple hemorrhagic lesions (p = 0.010) were associated with worsening of repeat CT, neurological deterioration, and/or need for neurosurgical intervention.CONCLUSIONSThe role of routine repeat head CT in medically managed patients with head injury is controversial. The authors have tried to study the various factors that are associated with neurological deterioration, radiological deterioration, and/or need for neurosurgical intervention. In this study the authors found lower GCS score at admission, abnormal INR, presence of midline shift, effaced basal cisterns, and multiple lesions on initial CT to be significantly associated with the above outcomes.

Unnecessary Head Computed Tomography Scans: A Level 1 Trauma Teaching Experience

2014 ◽  
Vol 80 (7) ◽  
pp. 664-668 ◽  
Author(s):  
Carolyn Parma ◽  
Daniel Carney ◽  
Rod Grim ◽  
Ted Bell ◽  
Kimberly Shoff ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Injury Severity ◽  
Teaching Experience ◽  
Ct Scans ◽  
Head Ct ◽  
Severity Scores ◽  
Level I ◽  
Reducing Costs ◽  
Head Computed Tomography

The Canadian CT Head Rule attempts to standardize the practice of obtaining head computed tomography (CT) scans in patients with minor head injury. Previous research indicates 10 to 35 per cent of CT scans performed do not meet these guidelines. The purpose of this study was to review our use of CT scans in the evaluation of mild traumatic brain injury and to identify 1) unnecessary head CT scans (UHCT); 2) variables associated with UHCT; and 3) associated costs. Using a trauma registry, inclusion criteria were age older than 18 years, Glasgow Coma Scale of 15, and at least one head CT scan. UHCTs were those without head injury, loss of consciousness, amnesia, or neurologic complaint. The proportion of patients meeting the criteria for UHCT was 24.2 per cent. Univariate analyses revealed ages 41 to 64 years, drug use, vehicular injury, and surgery within 24 hours were associated with UHCT (all P < 0.05). UHCTs were associated with higher Injury Severity Scores ( P = 0.008), ventilator days, and length of stay (all P < 0.05). An average cost of $1,413 per CT equals $149,778 in extra costs. This study suggests that current practices at our Level I trauma center result in UHCT. Further investigation into best practices would benefit our center by reducing costs and providing quality patient care.

A primer in interpretation of head CT scans

2019 ◽  
Vol 80 (11) ◽  
pp. C156-C161
Author(s):  
Saminderjit Kular ◽  
Andrew Martin
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Intracranial Haemorrhage ◽  
Skull Fracture ◽  
Ct Scans ◽  
Head Ct ◽  
Scanning Time ◽  
Stroke Team ◽  
Ct Head ◽  
The Brain

Over recent years with the development of increasingly efficient scanners, the computed tomography (CT) scan of the head has become one of the most commonly requested initial investigations, used to provide an overview of the brain and its surrounding structures. In particular, the CT head scan has become significant in the trauma setting. With short scanning time, an investigation to confirm or exclude intracranial haemorrhage, skull fracture or stroke can now be performed in a matter of seconds. This article provides physicians with a structure for reading a CT head scan, to help identify key findings that may warrant further specialist neurosurgical or stroke team referral.

Diagnostic Accuracy of Magnetic Resonance Imaging and Computed Tomography Scan in Young Athletes With Spondylolysis

2019 ◽  
Vol 58 (6) ◽  
pp. 671-676
Author(s):  
Amy M. West ◽  
Pierre A. d’Hemecourt ◽  
Olivia J. Bono ◽  
Lyle J. Micheli ◽  
Dai Sugimoto
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Ct Scan ◽  
False Negative ◽  
False Negative Rate ◽  
Ct Scans ◽  
Resonance Imaging ◽  
Young Athletes ◽  
Negative Rate

The objective of this study was to determine diagnostic accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) scans in young athletes diagnosed with spondylolysis. A cross-sectional study was used. Twenty-two young athletes (14.7 ± 1.5 years) were diagnosed as spondylolysis based on a single-photon emission CT. Following the diagnosis, participants underwent MRI and CT scan imaging tests on the same day. The sensitivity and false-negative rate of the MRI and CT scans were analyzed. MRI test confirmed 13 (+) and 9 (−) results while CT test showed 17 (+) and 5 (−) results. The sensitivity and false-negative rate of MRI were, respectively, 59.1% (95% confidence interval [CI] = 36.7% to 78.5%) and 40.9% (95% CI = 21.5% to 63.3%). Furthermore, the sensitivity and false-negative rate of CT scan were 77.3% (95% CI = 54.2% to 91.3%) and 22.7% (95% CI = 0.09% to 45.8%). Our results indicated that CT scan is a more accurate imaging modality to diagnose spondylolysis compared with MRI in young athletes.

scholarly journals The Effect of Contrast-enhanced Computed Tomography (CT) Scans on the Calculated Dose of Radiotherapy in a Thorax Phantom

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Athar Ehtiati ◽  
Payman Hejazi ◽  
Mohsen Bakhshandeh ◽  
Ali Jabbary Arfaee ◽  
Eftekhar Rajab Bolookat ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Contrast Media ◽  
Ct Scan ◽  
Treatment Planning ◽  
Tumor Volume ◽  
Ct Scans ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Background: Despite the benefits of contrast-enhanced computed tomography (CT) scans in better tumor volume delineation, it can affect the accuracy of dose calculation in radiation therapy. This study examined this effect on a thorax phantom. Objectives: The influence of different variables including the concentrations of the Visipaque contrast media, tumor sizes, and CT scan energies on the dose measurement was examined. Methods: Transparent cylinders containing the contrast media were inserted in the lung area of the phantom and the CT scans were made. Non-enhanced CT scans were also acquired. Treatment planning using 2 opposite fields was performed on the CT scans and the doses were calculated in the treatment planning system. The results of the 2 sets of enhanced and non-enhanced CT scans were compared. Results: The correlation between concentration and the percentage of mean dose of the tumor volume was significant in 2 of the tumor sizes. The differences in the mean doses of the 2 plans were examined and more than 3% increase was observed in higher concentrations of the contrast media. Conclusions: According to this study, the suitable concentration of the contrast media administered and the CT scan energy should be considered. This would help to decrease the discrepancies between the calculated and delivered dose in radiotherapy treatments to a clinically acceptable level. The importance of time delays for CT scans after administration of the contrast media is emphasized.

scholarly journals Enlargement of Post-Traumatic Intracerebral Haematoma: Incidence and Time Course

2005 ◽  
Vol 33 (1) ◽  
pp. 119-122 ◽  
Author(s):  
WG Liu ◽  
Y Yao ◽  
JY Zhou ◽  
XF Yang
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Time Course ◽  
Ct Scans ◽  
Intracerebral Haematoma ◽  
Automated Method ◽  
Haematoma Volume ◽  
Traumatic Intracerebral Haematoma ◽  
Radiographic Criterion ◽  
Post Traumatic

We retrospectively assessed the incidence and time course of enlargement in posttraumatic intracerebral haematoma (PTICH). Computed tomography (CT) scans from 165 patients who underwent a scan within 72 h and a repeat scan within 120 h of the onset of trauma were examined. A semi-automated method using region deformation-based segmentation was used to calculate the haematoma volume. The presence of haematoma enlargement was also determined based on a consensus by five observers. Seventy cases (42%) showed enlargement of the haematoma. The frequency of haematoma enlargement decreased as the interval between the onset of trauma and the initial scan increased. The discriminant value of the ratio of the haematoma volume in the second scan to that in the initial scan was ascertained, and the cut-off value for haematoma enlargement was determined to be 1.45. The radiographic criterion for enlargement in PTICH on CT scan was, therefore, defined as a ≥ 1.45 times increase in haematoma volume.

Prospective Study of the Correlation Between Postoperative Computed Tomography Scan and Primary Surgeon Assessment in Patients With Advanced Ovarian, Tubal, and Peritoneal Carcinoma Reported to Have Undergone Primary Surgical Cytoreduction to Residual Disease 1 cm or Less

2007 ◽  
Vol 25 (31) ◽  
pp. 4946-4951 ◽  
Author(s):  
Dennis S. Chi ◽  
Pedro T. Ramirez ◽  
Jerrold B. Teitcher ◽  
Svetlana Mironov ◽  
Debra M. Sarasohn ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Ct Scans ◽  
Eligibility Criteria ◽  
Primary Surgery ◽  
The Right ◽  
Analysis Scale ◽  
Tomography Scan

Purpose To compare surgeons' operative assessments of residual disease (RD) to those identified on postoperative computed tomography (CT) scans in patients with advanced ovarian carcinoma reported to have undergone optimal primary cytoreduction. Patients and Methods All patients at one of two institutions, who were scheduled to have primary surgery for presumed advanced ovarian cancer, were asked to consent to a postoperative CT scan if cytoreduction to ≤ 1 cm RD was reported. CT scan findings were graded using a qualitative analysis scale from 1 (normal) to 5 (definitely malignant). Results From January 2001 to September 2006, 285 patients were enrolled. A total of 78 patients met eligibility criteria and had postoperative CT scans. In 41 cases (52%), postoperative scan findings correlated with the surgical report of no RD more than 1 cm, and in seven cases (9%), the CT findings were indeterminate. In 10 cases (13%), more than 1 cm RD was noted by the radiologist as probably malignant, and in 20 cases (26%), definitely malignant. In these 30 cases, the radiologically reported median largest residual mass was 1.9 cm (range, 1.1 to 5.1), with RD more than 1 cm reported most commonly in the right upper quadrant (15 patients [50%]) and central abdomen (nine patients [30%]). Conclusion There was only a 52% correlation between surgeons' assessments and postoperative CT scan evaluations of RD in patients reported to have undergone optimal cytoreduction. Further study is required to determine whether this lack of correlation is due to rapid interval tumor regrowth, RD underestimated by the surgeons, and/or overestimated by the radiologists; and to determine the clinical implications of these discrepancies.

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