Don't redo CT for mild head trauma if patient is stable

An initial CT exam after mild head trauma is a good idea because it can show bleeding in the brain. Repeating the scan, however, is unlikely to yield additional benefits or change management if the patient is stable, according to a new study in the January issue of Neurosurgery.

Researchers from McMaster University in Hamilton, Ontario, questioned the need for obtaining repeat CT scans in the setting of mild head trauma. The available evidence indicates that it is unnecessary when patients are unchanged or improving neurologically, wrote Dr. Saleh Almenawer and colleagues (Neurosurgery, January 2013, Vol. 72:1, pp. 56-64).

A review of the hospital's trauma database revealed 445 adult patients with mild head injury who had evidence of intracranial hemorrhage (ICH) at the initial CT scan. In many centers, it is standard practice to schedule a second scan when the first one is positive for ICH.

The study team sought to determine how many patients with ICH needed surgery or other treatment, and whether the decision to intervene was based on the patient's changing neurological condition or the second CT scan. Patients whose neurological condition worsened were rescanned immediately, the group noted.

A total of 5.6% of the patients needed a change in management after the second CT scan, with most receiving craniectomy surgery to relieve pressure on the brain. Nearly all patients who underwent further treatment developed neurological changes leading to immediate CT scanning; only two patients needed further treatment based solely on the CT scan.

Neurological examination is the crucial predictive factor leading to changes in treatment and guiding the need for repeat CT scanning after mild head injury, the researchers concluded. The findings do not necessarily apply to patients with more severe head injuries, they noted.

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