Information sourced from NEJM Journal Watch:
Patients with Mild Head Injury and Intracranial Bleed Do Not Need Repeat Imaging
In the face of a normal neurological exam, repeat imaging only adds hospital days and costs.
Investigators retrospectively reviewed the charts of 321 patients presenting to a single trauma center over a 5-year period with mild head injury, intracranial bleeding, and normal neurologic status (Glasgow Coma Scale [GCS] score, 15) 24 hours after arrival. Outcomes for patients who underwent repeat head computed tomography (CT; 142) were compared with those who did not (179). A mild head injury was defined as one associated with loss of consciousness, retrograde amnesia, or both and a GCS score >12 on arrival.
Demographics, injury severity, and disposition from the emergency department or hospital were similar for both groups. No patient in either group required neurosurgical intervention or change in management, and none died; all had favorable neurologic outcomes. The rate of home discharge was the same for both groups (97%), but patients who did not undergo repeat CT had significantly shorter lengths of stay (mean, 2.2 days vs. 4.3 days). Disposition type (home, rehab, etc.) was the same for both groups.
With little supporting evidence, current recommendations for patients with mild head injury and intracranial bleeding call for repeat computed tomography (CT) within 24 hours regardless of mental status. These results show that repeat scans add nothing except increased radiation, hospital days, and expense. The decision to obtain a repeat CT scan in such patients should be based on clinical deterioration.
Richard D. Zane, MD, FAAEM reviewing Nayak NV et al. J Trauma Acute Care Surg 2013 Aug.
Nayak NV et al. Neurologic outcome of minimal head injury patients managed with or without a routine repeat head computed tomography. J Trauma Acute Care Surg 2013 Aug; 75:273. [PubMed ® abstract]
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