Is Routine Brain CT Scan, Performed for Early Follow Up in Head Trauma Patients with GCS 14-15, Always Justified?

Mild Traumatic Brain Injury (TBI) is common, with an estimated incidence between 100-300 cases per 100,000 people in the Western world [1]. Over 1.7 million Americans present to emergency departments with TBI where, overall, in the United States alone, it results in 52000 deaths and 275000 hospital admissions annually and is a contributing factor in one-third of all injury-related deaths [2]. Of all TBI patients, >80% of cases could be classified as Minimal Head Injuries, (MHI) where there may or may not be loss of consciousness and/or post-traumatic retrograde amnesia but where the presenting Glasgow Coma Scale (GCS) exceeds 12 [3,4]. When patients presenting with MHI have an Intracranial Hemorrhage (ICH) detected by initial head CT, a standard of care in many institutions is to obtain a second follow-up CT scan within 24 hours (a repeat CT-RCT) in order to define the need for neurosurgical intervention or patient transfer to a neurosurgical unit. These decisions have hitherto largely been made independently of the patient's clinical neurological status. This protocol has been designed to rule out progression of an intracranial bleed and to evaluate the manageable aspects of secondary brain injury. Although the performance of an RCT in MHI with attendant ICH is well established, it has been little tested [5]. Assessment of the clinical value of this protocol will assist in the timely transfer of high risk cases and will better direct the discharge of TBI patients as well as reduce hospital costs and diminish unwarranted radiation exposure [6-8].