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.

scholarly journals Outcome Prediction in Patients of Traumatic Brain Injury Based on Midline Shift on CT Scan of Brain

2021 ◽  
Author(s):  
Shrikant Govindrao Palekar ◽  
Manish Jaiswal ◽  
Mandar Patil ◽  
Vijay Malpathak
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Ct Scan ◽  
Treatment Protocol ◽  
Emergency Setting ◽  
Midline Shift ◽  
Ct Head ◽  
Clinical Tools ◽  
Gcs Score

Abstract Background Clinicians treating patients with head injury often take decisions based on their assessment of prognosis. Assessment of prognosis could help communication with a patient and the family. One of the most widely used clinical tools for such prediction is the Glasgow coma scale (GCS); however, the tool has a limitation with regard to its use in patients who are under sedation, are intubated, or under the influence of alcohol or psychoactive drugs. CT scan findings such as status of basal cistern, midline shift, associated traumatic subarachnoid hemorrhage (SAH), and intraventricular hemorrhage are useful indicators in predicting outcome and also considered as valid options for prognostication of the patients with traumatic brain injury (TBI), especially in emergency setting. Materials and Methods 108 patients of head injury were assessed at admission with clinical examination, history, and CT scan of brain. CT findings were classified according to type of lesion and midline shift correlated to GCS score at admission. All the subjects in this study were managed with an identical treatment protocol. Outcome of these patients were assessed on GCS score at discharge. Result Among patients with severe GCS, 51% had midline shift. The degree of midline shift in CT head was a statistically significant determinant of outcome (p = 0.023). Seventeen out of 48 patients (35.4%) with midline shift had poor outcome as compared with 8 out of 60 patients (13.3%) with no midline shift. Conclusion In patients with TBI, the degree of midline shift on CT scan was significantly related to the severity of head injury and resulted in poor clinical outcome.

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.

Are routine repeat imaging and intensive care unit admission necessary in mild traumatic brain injury?

2012 ◽  
Vol 116 (3) ◽  
pp. 549-557 ◽  
Author(s):  
Chad W. Washington ◽  
Robert L. Grubb
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scans ◽  
Imaging Data ◽  
Inclusion Criteria ◽  
Mild Tbi ◽  
Head Ct ◽  
Gcs Score ◽  
Repeat Imaging ◽  
Neurosurgical Intervention

Object More than 1.5 million Americans suffer a traumatic brain injury (TBI) each year. Seventy-five percent of these patients have a mild TBI, with Glasgow Coma Scale (GCS) Score 13–15. At the authors' institution, the usual practice has been to admit those patients with an associated intracranial hemorrhage (ICH) to an ICU and to obtain repeat head CT scans 12–24 hours after admission. The purpose of this study was to determine if there exists a subpopulation of mild TBI patients with an abnormal head CT scan that requires neither repeat brain imaging nor admission to an ICU. This group of patients was further classified based on initial clinical factors and imaging characteristics. Methods A retrospective review of all patients admitted to a Level I trauma center from January 2007 through December 2008 was performed using the hospital Trauma Registry Database, medical records, and imaging data. The inclusion criteria were as follows: 1) an admission GCS score ≥ 13; 2) an isolated head injury with no other injury requiring ICU admission; 3) an initial head CT scan positive for ICH; and 4) an initial management plan that was nonoperative. Collected data included age, etiology, initial GCS score, time of injury, duration of ICU stay, duration of hospital stay, and anticoagulation status. Primary outcomes measured were the occurrence of neurological or medical decline and the need for neurosurgical intervention. Imaging data were analyzed and classified based on the predominant blood distribution found on admission imaging. Data were further categorized based on the Marshall CT classification, Rotterdam score, and volume of intraparenchymal hemorrhage (IPH). Progression was defined as an increase in the Marshall classification, an increase in the Rotterdam score, or a 30% increase in IPH volume. Results Three hundred twenty-one of 1101 reviewed cases met inclusion criteria for the study. Only 4 patients (1%) suffered a neurological decline and 4 (1%) required nonemergent neurosurgical intervention. There was a medical decline in 18 of the patients (6%) as a result of a combination of events such as respiratory distress, myocardial infarction, and sepsis. Both patient age and the transfusion of blood products were significant predictors of medical decline. Overall patient mortality was 1%. Based on imaging data, the rate of injury progression was 6%. The only type of ICH found to have a significant rate of progression (53%) was a subfrontal/temporal intraparenchymal contusion. Other variables found to be significant predictors of progression on head CT scans were the use of anticoagulation, an age over 65 years, and a volume of ICH > 10 ml. Conclusions Most patients with mild TBI have a good outcome without the necessity of neurosurgical intervention. Mild TBI patients with a convexity SAH, small convexity contusion, small IPH (≤ 10 ml), and/or small subdural hematoma do not require admission to an ICU or repeat imaging in the absence of a neurological decline.

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.

Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy

1998 ◽  
Vol 89 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
Abhijit Guha ◽  
Andres Lozano ◽  
Mark Bernstein
Keyword(s):  
Ct Scan ◽  
Neurological Deficit ◽  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Ct Scanning ◽  
Ct Scans ◽  
Stereotactic Brain Biopsy ◽  
Content Type ◽  
Fine Print

Object. Many neurosurgeons routinely obtain computerized tomography (CT) scans to rule out hemorrhage in patients after stereotactic procedures. In the present prospective study, the authors investigated the rate of silent hemorrhage and delayed deterioration after stereotactic biopsy sampling and the role of postbiopsy CT scanning. Methods. A subset of patients (the last 102 of approximately 800 patients) who underwent stereotactic brain biopsies at the Toronto Hospital prospectively underwent routine postoperative CT scanning within hours of the biopsy procedure. Their medical charts and CT scans were then reviewed. A postoperative CT scan was obtained in 102 patients (aged 17–87 years) who underwent stereotactic biopsy between June 1994 and September 1996. Sixty-one patients (59.8%) exhibited hemorrhages, mostly intracerebral (54.9%), on the immediate postoperative scan. Only six of these patients were clinically suspected to have suffered a hemorrhage based on immediate postoperative neurological deficit; in the remaining 55 (53.9%) of 102 patients, the hemorrhage was clinically silent and unsuspected. Among the clinically silent intracerebral hemorrhages, 22 measured less than 5 mm, 20 between 5 and 10 mm, five between 10 and 30 mm, and four between 30 and 40 mm. Of the 55 patients with clinically silent hemorrhages, only three demonstrated a delayed neurological deficit (one case of seizure and two cases of progressive loss of consciousness) and these all occurred within the first 2 postoperative days. Of the neurologically well patients in whom no hemorrhage was demonstrated on initial postoperative CT scan, none experienced delayed deterioration. Conclusions. Clinically silent hemorrhage after stereotactic biopsy is very common. However, the authors did not find that knowledge of its existence ultimately affected individual patient management or outcome. The authors, therefore, suggest that the most important role of postoperative CT scanning is to screen for those neurologically well patients with no hemorrhage. These patients could safely be discharged on the same day they underwent biopsy.

Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury

1984 ◽  
Vol 61 (4) ◽  
pp. 691-694 ◽  
Author(s):  
Steven M. Toutant ◽  
Melville R. Klauber ◽  
Lawrence F. Marshall ◽  
Belinda M. Toole ◽  
Sharon A. Bowers ◽  
...  
Keyword(s):  
Ct Scan ◽  
Ct Scanning ◽  
Data Bank ◽  
Second Phase ◽  
Content Type ◽  
Risk Of Death ◽  
The Status ◽  
Gcs Score ◽  
Basal Cisterns ◽  
Fine Print

✓ The relationship of outcome to the appearance of the basal cisterns as seen on initial computerized tomography (CT) scanning was assessed in 218 consecutive severely head-injured patients entered into the second phase of the National Pilot Traumatic Coma Data Bank. Outcome could be directly related to the status of the basal cisterns on the initial CT scan. The mortality rates were 77%, 39%, and 22% among those with absent, compressed, and normal basal cisterns, respectively. This association between cisterns and outcome was shown to be strong after adjusting for Glasgow Coma Scale (GCS) score (p < 0.001). The state of the cisterns was more important for those with higher GCS scores (scores 6 to 8) than for those with lower scores (scores 3 to 5). Patients with GCS scores of 6 to 8, with cisterns absent or not visualized, suffered nearly a fourfold additional risk of poor outcome, compared to those with normal cisterns. This indicates that the status of the cisterns can be used as an early noninvasive method of identifying patients at high risk of death or severe disability, in whom the initial neurological examination would potentially suggest otherwise.

scholarly journals Detection of Midline Shift from CT Scans to Predict Outcome in Patients with Head Injuries

2021 ◽  
Vol 11 (1) ◽  
pp. 18-23
Author(s):  
Ikhlas Abdelaziz ◽  
Rowa Aljondi ◽  
Ali Alhailiy ◽  
Mustafa Mahmoud
Keyword(s):  
Clinical Outcome ◽  
Brain Injuries ◽  
Head Injuries ◽  
Clinical Status ◽  
Ct Scans ◽  
Ct Scanner ◽  
Midline Shift ◽  
Medical Systems ◽  
Gcs Score ◽  
The Relationship

Background: The present study aimed to detect the degree of midline shift from CT scans and the clinical status of the patient, to evaluate the relationship between the degree of midline shift found by the CT scan and GCS score as a predictor of clinical outcome in head injury patients. Furthermore, we aimed to assess the relationship between midline shift and age, sex, and causes. Methods and Results: The study included 50 subjects (36 males and 14 females). The age range of the patients in this study was 18–95 years old (mean age of 48.34±17.02 years). The inclusion criteria were patients with traumatic brain injury (TBI) or patients evaluated for level of consciousness by a neurosurgeon. Toshiba 16 Slice CT scanner (Toshiba Medical Systems, Nasu, Japan 2003) was used to scan all patients in the supine, head first position. Contiguous 2 mm slices were obtained using the Toshiba 16-slice machine spiral technique (pitch 1.25–1.5, 0.75 s rotation time, 120 KvP, 2 mm reconstruction interval). The results indicated that the degree of midline shift in patients with brain injuries was statistically significant as a determinant of clinical outcome. It appeared that the probability of poor clinical outcome was higher when there was a combination of midline shift and other types of intracranial hemorrhage, clinical factors, such as sex, age, and GCS score, and associated injuries. The worst outcome was seen in patients with midline shift and subdural hematoma, when compared with other lesions in patients with brain injuries. Conclusion: This study suggests that the degree of midline shift may be predictive of clinical outcome in patients with head injuries.

The Use of Cranial CT Scans in the Triage of Pediatric Patients With Mild Head Injury

PEDIATRICS ◽  
1995 ◽  
Vol 95 (3) ◽  
pp. 345-349
Author(s):  
Robert L. Davis ◽  
Michael Hughes ◽  
K. Dean Gubler ◽  
Patti L. Waller ◽  
Frederick P. Rivara
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Ct Scan ◽  
Case Series ◽  
Ct Scans ◽  
Mild Head Injury ◽  
Retrospective Case ◽  
Cranial Ct ◽  
Case Series Study

Objective. Recent evidence suggests that patients with a normal cranial CT scan after head injury can be safely discharged home from the emergency department. However, supporting data from previous studies has relied on incomplete patient follow-up. We utilized a statewide comprehensive hospital abstract reporting system (CHARS) to assess whether children with normal CT scans after head injury subsequently developed intracranial sequelae in the month following their initial injury. Design. Retrospective case-series study, with comprehensive statewide follow-up for 1 month. Setting. The emergency department of a Level 1 Trauma Center in Seattle, Washington. Participants. All children (n = 400) with head injury, Glasgow Coma Score of 13 to 15, and initial normal CT scan seen over a 4.5-year time period. All were matched against CHARS to evaluate admissions within 30 days after emergency department disposition. For readmissions, International Classification of Diseases (9th revision) discharge and procedure information was collected. All children were also matched against the state death files. Results. Four children were readmitted for neurologic reasons within 1 month following injury. One child on coumadin for heart disease developed a symptomatic subdural hematoma 5 days after head injury, requiring neurosurgical drainage. One child developed a symptomatic hemorrhagic contusion 3 days after injury, requiring observation only. Two children were readmitted 1 day after injury for concussive symptoms; both were discharged home after observation only. There were no deaths among the study population. Conclusions. Among children with a normal cranial CT scan after mild head injury, delayed intracranial sequelae requiring intervention are extremely uncommon. In otherwise stable patients, a normal cranial CT scan can identify patients to be safely discharged from the emergency department, and would be more cost-effective than 1 to 2 days of hospital observation.

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