ROLE OF REPEAT CT SCAN BRAIN FOR PATIENTS WITH HEAD TRAUMA WHO ARE BEING MANAGED CONSERVATIVELY
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Abstract
Introduction: Traumatic Brain Injury (TBI) can result from a number of factors such as a simple blow to the head or it can be a result of sever penetrating trauma to skull.
Objective: To find out the efficacy of repeat CT scan in guiding management of patient with mild traumatic brain injury.
Material and methods: This Prospective observational study was conducted at Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad during July 2023 to June 2024. Patients presenting to the ER department were enrolled in the study and managed according to ATLS guidelines. Those with mild traumatic brain injury were managed conservatively if the initial CT scan did not indicate the need for urgent surgical intervention. Patients managed conservatively underwent a repeat CT scan at a 4–6-hour interval or sooner if their clinical condition deteriorated.
Results: Data were collected from 227 patients according to criteria of the study. Mean age of the patients was 35.4 ± 10.2 years, of whom 154 (68%) were male and 73 (32%) were female. The mean Glasgow Coma Scale (GCS) score was 14.2 ± 1.1, indicating that most patients had mild head trauma. Vital signs at presentation showed an average blood pressure of 125/80± 15/10 mmHg and a mean heart rate of 78 ± 12 bpm. The most common mechanism of injury was road traffic accidents, accounting for 50% of cases, followed by falls (30%), assaults (12%), sports-related injuries (5%), and other causes (3%).
Conclusion: It is concluded that repeat CT scanning is essential for the effective management of patients with head trauma who are being managed conservatively. The repeat imaging significantly contributes to detecting changes in intracranial pathology, which can lead to timely surgical intervention and improved patient outcomes
Objective: To find out the efficacy of repeat CT scan in guiding management of patient with mild traumatic brain injury.
Material and methods: This Prospective observational study was conducted at Department of Neurosurgery, Pakistan Institute of Medical Sciences, Islamabad during July 2023 to June 2024. Patients presenting to the ER department were enrolled in the study and managed according to ATLS guidelines. Those with mild traumatic brain injury were managed conservatively if the initial CT scan did not indicate the need for urgent surgical intervention. Patients managed conservatively underwent a repeat CT scan at a 4–6-hour interval or sooner if their clinical condition deteriorated.
Results: Data were collected from 227 patients according to criteria of the study. Mean age of the patients was 35.4 ± 10.2 years, of whom 154 (68%) were male and 73 (32%) were female. The mean Glasgow Coma Scale (GCS) score was 14.2 ± 1.1, indicating that most patients had mild head trauma. Vital signs at presentation showed an average blood pressure of 125/80± 15/10 mmHg and a mean heart rate of 78 ± 12 bpm. The most common mechanism of injury was road traffic accidents, accounting for 50% of cases, followed by falls (30%), assaults (12%), sports-related injuries (5%), and other causes (3%).
Conclusion: It is concluded that repeat CT scanning is essential for the effective management of patients with head trauma who are being managed conservatively. The repeat imaging significantly contributes to detecting changes in intracranial pathology, which can lead to timely surgical intervention and improved patient outcomes
References
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5. Fadzil F, Mei AKC, Mohd Khairy A, Kumar R, Mohd Azli AN. Value of Repeat CT Brain in Mild Traumatic Brain Injury Patients with High Risk of Intracerebral Hemorrhage Progression. Int J Environ Res Public Health. 2022;19:14311. doi: 10.3390/ijerph192114311.
6. Rosen CB, Luy DD, Deane MR, Scalea TM, Stein DM. Routine repeat head CT may not be necessary for patients with mild TBI. Trauma Surg Acute Care Open. 2018;3:e000129. doi: 10.1136/tsaco-2017-000129.
7. Abdulla A, Sadanandan S. The clinical profile and outcome of conservatively managed traumatic brain injuries and its implications on the timing of repeat CT scans. Int Surg J. 2020;8:137. doi: 10.18203/2349-2902.isj20205871.
8. Moskopp ML, Moskopp D, Sannwald LW. Impact of early follow-up CT in the conservative management of traumatic brain injury on surgical decision making: A retrospective, single-center analysis with special respect to coagulopathy. Eur J Trauma Emerg Surg [Internet]. 2024 [cited 2024 Mar 30]; doi: 10.1007/s00068-024-02449-3.
9. Samples DC, Bounajem MT, Wallace DJ, Liao L, Tarasiewicz I. Role of follow-up CT scans in the management of traumatic pediatric epidural hematomas. Childs Nerv Syst. 2019;35:2195–2203. doi: 10.1007/s00381-019-04236-7.
10. Hanalioglu S, Hanalioglu D, Elbir C, Gulmez A, Sahin OS, Sahin B, Turkoglu ME, Kertmen HH. A Novel Decision-Support Tool (IniCT Score) for Repeat Head Computed Tomography in Pediatric Mild Traumatic Brain Injury. World Neurosurg. 2022;165:e102–e109. doi: 10.1016/j.wneu.2022.05.103.
2. Vella MA, Crandall ML, Patel MB. Acute Management of Traumatic Brain Injury. Surg Clin North Am. 2017;97:1015–1030. doi: 10.1016/j.suc.2017.06.003.
3. Jha S, Ghewade P. Management and Treatment of Traumatic Brain Injuries. Cureus [Internet]. 2022 [cited 2024 Mar 30]; doi: 10.7759/cureus.30617.
4. Levine Z. Mild traumatic brain injury: part 1: determining the need to scan. Can Fam Physician Med Fam Can. 2010;56:346–349. Cited: in: : PMID: 20393093.
5. Fadzil F, Mei AKC, Mohd Khairy A, Kumar R, Mohd Azli AN. Value of Repeat CT Brain in Mild Traumatic Brain Injury Patients with High Risk of Intracerebral Hemorrhage Progression. Int J Environ Res Public Health. 2022;19:14311. doi: 10.3390/ijerph192114311.
6. Rosen CB, Luy DD, Deane MR, Scalea TM, Stein DM. Routine repeat head CT may not be necessary for patients with mild TBI. Trauma Surg Acute Care Open. 2018;3:e000129. doi: 10.1136/tsaco-2017-000129.
7. Abdulla A, Sadanandan S. The clinical profile and outcome of conservatively managed traumatic brain injuries and its implications on the timing of repeat CT scans. Int Surg J. 2020;8:137. doi: 10.18203/2349-2902.isj20205871.
8. Moskopp ML, Moskopp D, Sannwald LW. Impact of early follow-up CT in the conservative management of traumatic brain injury on surgical decision making: A retrospective, single-center analysis with special respect to coagulopathy. Eur J Trauma Emerg Surg [Internet]. 2024 [cited 2024 Mar 30]; doi: 10.1007/s00068-024-02449-3.
9. Samples DC, Bounajem MT, Wallace DJ, Liao L, Tarasiewicz I. Role of follow-up CT scans in the management of traumatic pediatric epidural hematomas. Childs Nerv Syst. 2019;35:2195–2203. doi: 10.1007/s00381-019-04236-7.
10. Hanalioglu S, Hanalioglu D, Elbir C, Gulmez A, Sahin OS, Sahin B, Turkoglu ME, Kertmen HH. A Novel Decision-Support Tool (IniCT Score) for Repeat Head Computed Tomography in Pediatric Mild Traumatic Brain Injury. World Neurosurg. 2022;165:e102–e109. doi: 10.1016/j.wneu.2022.05.103.
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Sep 15, 2024
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Dr Ali Raza, Professor Dr Lal Rehman, Dr Mujahid Shareef, Dr Naveed Ahmed, Dr Naveed khan, Dr Muhammad Najeeb, & Dr Mashal Rasool. (2024). ROLE OF REPEAT CT SCAN BRAIN FOR PATIENTS WITH HEAD TRAUMA WHO ARE BEING MANAGED CONSERVATIVELY. Journal of Population Therapeutics and Clinical Pharmacology, 31(9), 3984-3989. https://doi.org/10.53555/gw0t8239
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Author Biographies
Dr Ali Raza
Neurosurgical Resident PIMS, Islamabad
Professor Dr Lal Rehman
Head of Department Neurosurgery PIMS, Islamabad
Dr Mujahid Shareef
Assistant professor Neurosurgery department PIMS, Islamabad
Dr Naveed Ahmed
Neurosurgical Resident
Dr Naveed khan
Neurosurgical Resident PIMS, Islamabad
Dr Muhammad Najeeb
Neurosurgical Resident PIMS, Islamabad
Dr Mashal Rasool
FCPS Neurosurgery
How to Cite
Dr Ali Raza, Professor Dr Lal Rehman, Dr Mujahid Shareef, Dr Naveed Ahmed, Dr Naveed khan, Dr Muhammad Najeeb, & Dr Mashal Rasool. (2024). ROLE OF REPEAT CT SCAN BRAIN FOR PATIENTS WITH HEAD TRAUMA WHO ARE BEING MANAGED CONSERVATIVELY. Journal of Population Therapeutics and Clinical Pharmacology, 31(9), 3984-3989. https://doi.org/10.53555/gw0t8239