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Is repeat head CT necessary in patients with mild traumatic intracranial hemorrhage

  • Jonathan Van Ornam
    Affiliations
    Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America

    Harvard Affiliated Emergency Medicine Residency, Boston, MA 02114, United States of America
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  • Peter Pruitt
    Affiliations
    Northwestern University, Chicago, IL 60611, United States of America
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  • Pierre Borczuk
    Correspondence
    Corresponding author at: Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital, Five Emerson Place, Boston, MA 02114, United States of America.
    Affiliations
    Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America

    Harvard Affiliated Emergency Medicine Residency, Boston, MA 02114, United States of America
    Search for articles by this author
Published:December 10, 2018DOI:https://doi.org/10.1016/j.ajem.2018.12.012

      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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