Utility of Repeat Head CT on Mild Traumatic Brain Injury Patients

First Author(s)

• CW

  Candace Ward, MD, MPH,

  n/a
  Philadelphia

  Disclosure information not submitted.

  Slides and Audio

Co-Author(s)

• 

  Ryan Cohen, MD

  n/a
  Philadelphia, Pennsylvania

  Disclosure information not submitted.
• SO

  Samantha Olafson, MD

  Surgical Resident
  Einstein Healthcare Network, United States

  Disclosure information not submitted.
• AG

  Austin Goetz, MD

  General Surgeon
  Crozer Health, United States

  Disclosure information not submitted.
• PL

  Pak Shan Leung, MD, MS, FACS

  Associate Chair of Trauma and Surgical Critical Care
  Einstein Medical Center Philadelphia, United States

  Disclosure information not submitted.
• JS

  Jay Strain, MD, FACS

  Assistant Professor of Surgery
  Einstein Healthcare Network, United States

  Disclosure information not submitted.
• BM

  Benjamin Moran, MD, FACS

  Trauma and Acute Care Surgeon
  Einstein Healthcare Network, United States

  Disclosure information not submitted.
• AP

  Afshin Parsikia, MD, MPH

  Director of Surgical Research
  Einstein Healthcare Network, United States

  Disclosure information not submitted.
• MK

  Mark Kaplan, MD

  Chair of Trauma and Surgical Critical Care
  Einstein Medical Center Philadelphia, United States

  Disclosure information not submitted.

Title: Utility of repeat head CT on mild traumatic brain injury patients

Background:  Patients presenting with traumatic intracranial hemorrhage (ICH) routinely undergo repeat head CT scans with the goal of identifying progressing hemorrhage early and providing timely intervention. Glasgow Coma Scale (GCS) score and Abbreviated Injury Score (AIS) are typically used to grade the severity of TBI and triage subsequent management. However, most patients receive a repeat head CT scan within 6 hours of the initial insult, regardless of these clinical scores. We investigated the yield of a repeat CT scan, for mild blunt TBI (GCS 13-15, AIS 1-2) in light of increased healthcare cost and radiation exposure.

Methods:  This was a single-center retrospective chart review at a level 1 trauma between January 2012 to October2020. Our primary outcome was the need for medical or surgical intervention directly resulted from change in CT head findings. Secondary endpoints included discharge disposition and length of stay (overall and ICU). We used multivariate regression to identify predictors of surgical and medical intervention.

Results:  234 mild TBI patients met inclusion criteria. 33.7% of all patients had worsening ICH. 7.7% of patients required a surgical intervention, and 27.4% received a medical intervention. Multivariate analysis found that a decline in GCS during hospital stay (OR 8.64, p< .001), and polytrauma (ISS > 15; OR 3.32, p=.038) predicted surgical intervention. Worsening ICH did not reach statistical significance to predict surgical intervention. Patients that received a medical intervention were more likely to have a decline in GCS (OR 2.53, p=.02) and older (age >65, OR 2.06, p=.02). Worsening ICH was not statistically significant for a medical intervention.

Conclusion:  In the population of blunt traumatic injury, worsening ICH was not predictive of surgical or medical intervention. Changes in neurologic examination are more useful. Data suggests that routine CT scan for this population is low yield and decision to repeat it should be guided by clinical exam. Clinical exam remains the most useful tool in these patients.