Abstract
Background
Patients with traumatic intracranial hemorrhage (TIH) frequently receive repeat head
CT scans (RHCT) to assess for progression of TIH. The utility of this practice has
been brought into question, with some studies suggesting that in the absence of progressive
neurologic symptoms, the RHCT does not lead to clinical interventions.
Methods
This was a retrospective review of consecutive patients with CT-documented TIH and
GCS ≥ 13 presenting to an academic emergency department from 2009 to 2013. Demographic,
historical, and physical exam variables, number of CT scans during admission were
collected with primary outcomes of: neurological decline, worsening findings on repeat
CT scan, and the need for neurosurgical intervention.
Results
Of these 1126 patients with mild traumatic intracranial hemorrhage, 975 had RHCT.
Of these, 54 (5.5% (4.2–7.2 95 CI) had neurological decline, 73 (7.5% 5.9–9.3 95 CI)
had hemorrhage progression on repeat CT scan, and 58 (5.9% 4.5–7.6 95 CI) required
neurosurgical intervention. Only 3 patients (0.3% 0.1–0.9% 95 CI) underwent neurosurgical
intervention due to hemorrhage progression on repeat CT scan without neurological
decline. In this scenario, the number of RHCT scans needed to be performed to identify
this one patient is 305.
Conclusions
RHCT after initial findings of TIH and GCS ≥ 13 leading to a change to operative management
in the absence of neurologic progression is a rare event. A protocol that includes
selective RHCT including larger subdural hematomas or patients with coagulopathy (vitamin
K inhibitors and anti-platelet agents) may be a topic for further study.
Keywords
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Article Info
Publication History
Published online: December 10, 2018
Accepted:
December 8,
2018
Received in revised form:
December 3,
2018
Received:
June 18,
2018
Footnotes
☆Presented at the 2017 Society for Academic Emergency Medicine Annual Meeting, Orlando, FL.
Identification
Copyright
© 2018 Published by Elsevier Inc.
