Impact of Repeat Head Computed Tomography on Mild Traumatic Brain Injury Patients With Abbreviated Injury Score 1-2 Injuries.

Autor:	Ward CL; Department of Trauma and Critical Care, 6528Einstein Healthcare Network, Philadelphia, PA, USA., Cohen RB; Department of Trauma and Critical Care, 6528Einstein Healthcare Network, Philadelphia, PA, USA., Olafson SN; Department of Trauma and Critical Care, 6528Einstein Healthcare Network, Philadelphia, PA, USA., Goetz AB; Department of Surgery, Crozer Health, Upland, PA, USA., Leung P; Department of Trauma and Critical Care, 6528Einstein Healthcare Network, Philadelphia, PA, USA., Moran BJ; Department of Trauma and Critical Care, 6528Einstein Healthcare Network, Philadelphia, PA, USA., Strain JJ; Department of Trauma and Critical Care, 6528Einstein Healthcare Network, Philadelphia, PA, USA., Parsikia A; Department of Trauma and Critical Care, 6528Einstein Healthcare Network, Philadelphia, PA, USA., Kaplan MJ; Department of Trauma and Critical Care, 6528Einstein Healthcare Network, Philadelphia, PA, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2022 Aug; Vol. 88 (8), pp. 1946-1953. Date of Electronic Publication: 2022 Feb 27.
DOI:	10.1177/00031348221075763
Abstrakt:	Background: Patients presenting with traumatic intracranial hemorrhage (ICH) routinely undergo repeat head Computed Tomography (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 traumatic brain injury (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). Methods: This was a single-center retrospective chart review at a level 1 trauma center between 2009 and 2019. Our primary outcome was medical or surgical intervention directly resulted from change in CT head findings. 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 (OR 8.64), and polytrauma (Injury Severity Score >15; OR 3.32) predicted surgical intervention. Worsening ICH did not predict surgical or medical intervention. Patients requiring medical intervention were more likely to have a decline in GCS (OR 2.53, P = .02) and be older (age >65, OR 2.06, P = .02). Conclusion: In the population of blunt traumatic injury, worsening ICH did not predict surgical or medical intervention. Routine repeat imaging for this population is low yield, and clinical exam should guide the decision to reimage.
Databáze:	MEDLINE
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