Routinely Repeated Computed Tomography after Blunt Head Trauma: Does it Benefit Patients?

Krista L. Kaups, James W. Davis, Steven N. Parks, Steven R. Shackford, Peter B. Angood, Peter M Rhee, Alex B. Valadka

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Background: Computed tomography of the head (HCT) is an integral part of the diagnosis and management of the patient with head injury, but the utility of repeated HCT performed solely for routine follow-up in the patient with blunt head trauma has not been defined. In the absence of clinical indications, routinely repeated HCT, even in patients with significant brain injury, does not contribute to patient care. Methods: Trauma registry records at a Level I trauma center from July 1, 1997, to June 30, 2002, were reviewed. Patients with severe blunt head injury (Abbreviated Injury Scale score ≥ 3) admitted to the intensive care unit and who had a repeat HCT scan obtained for scheduled follow-up were included. Those patients with initial craniotomy, repeat HCT more than 72 hours after the initial HCT, or repeat HCT ordered for clinical indications were excluded. Data included were age, mechanism of injury, time to initial (HCT1) and repeat HCT (HCT2), indications for HCT2, and HCT findings. Additional data included Glasgow Coma Scale (GCS) score (admission and at HCT2) ; Injury Severity Score; occurrence of hypotension, coagulopathy, or elevated intracranial pressure (ICP); interventions made; and patient outcome. Rssults: Entry criteria were met in 462 patients. Most were injured in motor vehicle crashes; the average age was 36 years and the mean initial GCS score was 9. The mean time to HCT1 was 1.3 hours and the mean time to HCT2 was 22.6 hours. HCT2 showed worsening in 85 patients (18.4%), and 16 patients had interventions in response to HCT2 (repeat HCT in 8, ICP monitoring or drainage in 6, and craniotomy in 2). No patient undergoing routine repeat HCT without other clinical findings required intervention. All patients with worsening HCT findings requiring intervention had coagulopathy, hypotension, ICP elevation, or marked decrease in GCS score. Conclusion: In the absence of clinical indicators or risk factors, repeat HCT after blunt head injury does not alter patient management and is unnecessary.

Original languageEnglish (US)
Pages (from-to)475-481
Number of pages7
JournalJournal of Trauma
Volume56
Issue number3
StatePublished - Mar 2004
Externally publishedYes

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Craniocerebral Trauma
Tomography
Glasgow Coma Scale
Closed Head Injuries
Intracranial Hypertension
Craniotomy
Hypotension
Abbreviated Injury Scale
Injury Severity Score
Trauma Centers
Wounds and Injuries
Intracranial Pressure
Motor Vehicles
Brain Injuries
Intensive Care Units
Registries
Drainage
Patient Care
Head

Keywords

  • Brain injury
  • Closed head injury
  • Repeat computed tomography of the head

ASJC Scopus subject areas

  • Surgery

Cite this

Kaups, K. L., Davis, J. W., Parks, S. N., Shackford, S. R., Angood, P. B., Rhee, P. M., & Valadka, A. B. (2004). Routinely Repeated Computed Tomography after Blunt Head Trauma: Does it Benefit Patients? Journal of Trauma, 56(3), 475-481.

Routinely Repeated Computed Tomography after Blunt Head Trauma : Does it Benefit Patients? / Kaups, Krista L.; Davis, James W.; Parks, Steven N.; Shackford, Steven R.; Angood, Peter B.; Rhee, Peter M; Valadka, Alex B.

In: Journal of Trauma, Vol. 56, No. 3, 03.2004, p. 475-481.

Research output: Contribution to journalArticle

Kaups, KL, Davis, JW, Parks, SN, Shackford, SR, Angood, PB, Rhee, PM & Valadka, AB 2004, 'Routinely Repeated Computed Tomography after Blunt Head Trauma: Does it Benefit Patients?', Journal of Trauma, vol. 56, no. 3, pp. 475-481.
Kaups KL, Davis JW, Parks SN, Shackford SR, Angood PB, Rhee PM et al. Routinely Repeated Computed Tomography after Blunt Head Trauma: Does it Benefit Patients? Journal of Trauma. 2004 Mar;56(3):475-481.
Kaups, Krista L. ; Davis, James W. ; Parks, Steven N. ; Shackford, Steven R. ; Angood, Peter B. ; Rhee, Peter M ; Valadka, Alex B. / Routinely Repeated Computed Tomography after Blunt Head Trauma : Does it Benefit Patients?. In: Journal of Trauma. 2004 ; Vol. 56, No. 3. pp. 475-481.
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abstract = "Background: Computed tomography of the head (HCT) is an integral part of the diagnosis and management of the patient with head injury, but the utility of repeated HCT performed solely for routine follow-up in the patient with blunt head trauma has not been defined. In the absence of clinical indications, routinely repeated HCT, even in patients with significant brain injury, does not contribute to patient care. Methods: Trauma registry records at a Level I trauma center from July 1, 1997, to June 30, 2002, were reviewed. Patients with severe blunt head injury (Abbreviated Injury Scale score ≥ 3) admitted to the intensive care unit and who had a repeat HCT scan obtained for scheduled follow-up were included. Those patients with initial craniotomy, repeat HCT more than 72 hours after the initial HCT, or repeat HCT ordered for clinical indications were excluded. Data included were age, mechanism of injury, time to initial (HCT1) and repeat HCT (HCT2), indications for HCT2, and HCT findings. Additional data included Glasgow Coma Scale (GCS) score (admission and at HCT2) ; Injury Severity Score; occurrence of hypotension, coagulopathy, or elevated intracranial pressure (ICP); interventions made; and patient outcome. Rssults: Entry criteria were met in 462 patients. Most were injured in motor vehicle crashes; the average age was 36 years and the mean initial GCS score was 9. The mean time to HCT1 was 1.3 hours and the mean time to HCT2 was 22.6 hours. HCT2 showed worsening in 85 patients (18.4{\%}), and 16 patients had interventions in response to HCT2 (repeat HCT in 8, ICP monitoring or drainage in 6, and craniotomy in 2). No patient undergoing routine repeat HCT without other clinical findings required intervention. All patients with worsening HCT findings requiring intervention had coagulopathy, hypotension, ICP elevation, or marked decrease in GCS score. Conclusion: In the absence of clinical indicators or risk factors, repeat HCT after blunt head injury does not alter patient management and is unnecessary.",
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AU - Rhee, Peter M

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N2 - Background: Computed tomography of the head (HCT) is an integral part of the diagnosis and management of the patient with head injury, but the utility of repeated HCT performed solely for routine follow-up in the patient with blunt head trauma has not been defined. In the absence of clinical indications, routinely repeated HCT, even in patients with significant brain injury, does not contribute to patient care. Methods: Trauma registry records at a Level I trauma center from July 1, 1997, to June 30, 2002, were reviewed. Patients with severe blunt head injury (Abbreviated Injury Scale score ≥ 3) admitted to the intensive care unit and who had a repeat HCT scan obtained for scheduled follow-up were included. Those patients with initial craniotomy, repeat HCT more than 72 hours after the initial HCT, or repeat HCT ordered for clinical indications were excluded. Data included were age, mechanism of injury, time to initial (HCT1) and repeat HCT (HCT2), indications for HCT2, and HCT findings. Additional data included Glasgow Coma Scale (GCS) score (admission and at HCT2) ; Injury Severity Score; occurrence of hypotension, coagulopathy, or elevated intracranial pressure (ICP); interventions made; and patient outcome. Rssults: Entry criteria were met in 462 patients. Most were injured in motor vehicle crashes; the average age was 36 years and the mean initial GCS score was 9. The mean time to HCT1 was 1.3 hours and the mean time to HCT2 was 22.6 hours. HCT2 showed worsening in 85 patients (18.4%), and 16 patients had interventions in response to HCT2 (repeat HCT in 8, ICP monitoring or drainage in 6, and craniotomy in 2). No patient undergoing routine repeat HCT without other clinical findings required intervention. All patients with worsening HCT findings requiring intervention had coagulopathy, hypotension, ICP elevation, or marked decrease in GCS score. Conclusion: In the absence of clinical indicators or risk factors, repeat HCT after blunt head injury does not alter patient management and is unnecessary.

AB - Background: Computed tomography of the head (HCT) is an integral part of the diagnosis and management of the patient with head injury, but the utility of repeated HCT performed solely for routine follow-up in the patient with blunt head trauma has not been defined. In the absence of clinical indications, routinely repeated HCT, even in patients with significant brain injury, does not contribute to patient care. Methods: Trauma registry records at a Level I trauma center from July 1, 1997, to June 30, 2002, were reviewed. Patients with severe blunt head injury (Abbreviated Injury Scale score ≥ 3) admitted to the intensive care unit and who had a repeat HCT scan obtained for scheduled follow-up were included. Those patients with initial craniotomy, repeat HCT more than 72 hours after the initial HCT, or repeat HCT ordered for clinical indications were excluded. Data included were age, mechanism of injury, time to initial (HCT1) and repeat HCT (HCT2), indications for HCT2, and HCT findings. Additional data included Glasgow Coma Scale (GCS) score (admission and at HCT2) ; Injury Severity Score; occurrence of hypotension, coagulopathy, or elevated intracranial pressure (ICP); interventions made; and patient outcome. Rssults: Entry criteria were met in 462 patients. Most were injured in motor vehicle crashes; the average age was 36 years and the mean initial GCS score was 9. The mean time to HCT1 was 1.3 hours and the mean time to HCT2 was 22.6 hours. HCT2 showed worsening in 85 patients (18.4%), and 16 patients had interventions in response to HCT2 (repeat HCT in 8, ICP monitoring or drainage in 6, and craniotomy in 2). No patient undergoing routine repeat HCT without other clinical findings required intervention. All patients with worsening HCT findings requiring intervention had coagulopathy, hypotension, ICP elevation, or marked decrease in GCS score. Conclusion: In the absence of clinical indicators or risk factors, repeat HCT after blunt head injury does not alter patient management and is unnecessary.

KW - Brain injury

KW - Closed head injury

KW - Repeat computed tomography of the head

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