L. Michos1, S. Gummadi2, O. Galloway1, A. Kohli1 1Lankenau Medical Center, Wynnewood, PA, USA 2Hospital Of The University Of Pennsylvania, Philadelphia, PA, USA
Introduction: Routine repeat CT head imaging of trauma patients with Traumatic Brain Injury (TBI) within 24 hours has been a standard of practice. However, the literature does not show the optimal timing of these repeat CT scans to determine need for neurosurgical intervention. The objective of our study is to determine the optimal timing of routine repeat head CTs (CTH) in patients with TBI to assess for progression of injury and determine need for neurosurgical intervention. We hypothesized that patients with a high Injury Severity Score (ISS) receiving repeat CTH less than 12 hours from the initial scan would show progression and a higher rate of neurosurgical intervention.
Methods: Retrospective study was performed at a level 2 trauma center included patients from January 2020 to January 2022. All patients diagnosed with a TBI on initial CTH who did not undergo immediate neurosurgical intervention and underwent a repeat interval CTH were included. Univariate analysis was used to assess patients who underwent intervention vs those who did not to compare the role of early repeat CT imaging.
Results: 560 patients fulfilled inclusion criteria. 15 patients (2.7%) required neurosurgical intervention after repeat imaging. There was a significantly higher proportion of interval repeat CTH performed early (within 12 hours) in patients ultimately undergoing neurosurgical intervention compared with those that did not (0.80 vs 0.473, p=0.0165). The patients taken for intervention after repeat imaging had a significantly higher ISS (p= 0.0001) and tended to have a lower GCS on admission (p=0.0573).
Conclusion: These findings suggest that there is value in obtaining early repeat CTH (< 12 hours) in carefully selected populations that may include more injured patients or patients with a lower admission GCS. However, identification of this high risk population requires further analysis.
