Value of repeat cranial computed axial tomography scanning in patients with minimal head injury.

BACKGROUND Patients with minimal head injury (MHI) and a cranial computed axial tomography (CAT) scan positive for the presence of intracranial injury routinely undergo a repeat CAT scan within 24 hours after injury. The value of this repeat cranial CAT scan is unclear in those patients who are neurologically normal or improving. METHODS A retrospective analysis of all adult patients admitted to a level-1 trauma center with MHI and a positive cranial CAT scan during a 32-month period was performed. The need for neurosurgical intervention after repeat CAT scan in patients with a persistently normal or improved neurological examination was recorded. RESULTS One hundred fifty-one patients had a persistently normal or improved neurological examination, but none of these patients required neurosurgical intervention after the repeat cranial CAT scan. CONCLUSIONS A persistently normal or improving neurological examination in a patient with MHI appears to exclude the need for neurosurgical intervention and thus a repeat cranial CAT scan.

[1]  George A Wells,et al.  The Canadian CT Head Rule for patients with minor head injury , 2001, The Lancet.

[2]  M. Pasquale,et al.  Practice management guidelines for the management of mild traumatic brain injury: the EAST practice management guidelines work group. , 2001, The Journal of trauma.

[3]  J. Skurnick,et al.  Emergency department discharge of patients with a negative cranial computed tomography scan after minimal head injury. , 2000, Annals of surgery.

[4]  U. Tabori,et al.  Repeat computed tomographic scan within 24‐48 hours of admission in children with moderate and severe head trauma , 2000, Critical care medicine.

[5]  D. Livingston,et al.  Minimal head injury: is admission necessary? , 1991, The American surgeon.

[6]  D. E. Uddin,et al.  Predictors of positive CT scans in the trauma patient with minor head injury. , 1994, The American surgeon.

[7]  R. Derlet,et al.  Utilizing clinical factors to reduce head CT scan ordering for minor head trauma patients. , 1997, The Journal of emergency medicine.

[8]  P. Rhee,et al.  Utility of routine serial computed tomography for blunt intracranial injury. , 2001, The Journal of trauma.

[9]  J. Morris,et al.  The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries. , 1992, The Journal of trauma.

[10]  The Use of CT Scanning to Triage Patients Requiring Admission Following Minimal Head Injury , 1990 .

[11]  B. Green,et al.  Follow-up computerized tomography (CT) scans in moderate and severe head injuries: Correlation with Glasgow coma scores (GCS), and complication rate , 2005, Acta Neurochirurgica.

[12]  K. Nagy,et al.  The utility of head computed tomography after minimal head injury. , 1999, The Journal of trauma.

[13]  T. Mills,et al.  Indications for computed tomography in patients with minor head injury. , 2000, The New England journal of medicine.