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Repeat CT after blunt head trauma and Glasgow Coma Scale score 13–15 without neurological deterioration is very low yield for intervention

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Due to the increase in accessibility of computed tomography (CT), repeat head CT scans are routinely ordered for patients with minor head injuries. The aim of this study is to evaluate the necessity and outcomes of routine repeat head CT in patients with GCS score of 13–15 who presented to the emergency department (ED) of Antalya University Hospital in Turkey with blunt head trauma.

Methods

We retrospectively reviewed the charts of patients with minor head trauma that received initial and repeat head CT results from July 1, 2013 to June 30, 2015. Clinical characteristics of patients were compared for two groups of patients: those with neurological deterioration, and those who had routine head CT not required by change in neurological status. Repeat head CT results were analyzed for radiological worsening and the necessity of a surgical or medical intervention such as craniotomy, ICP monitoring, VP shunt and mannitol or hypertonic saline administration.

Results

Of 3578 patients with blunt head trauma, 656 (18.3%) patients had repeat head CT; 449 of these (68.4%) had a GCS score of 13–15. We analyzed 441 patients for CT and clinical changes. Eight patients were excluded because of poor image quality and/or penetrating injury. Neurological deterioration was the reason for repeat head CT in 73 (16.5%) patients Rates of medical (mannitol treatment) or surgical (craniotomy) intervention in this group were 26% (95% Confidence Interval [95% CI], 15.7–36.3%) in contrast to 0.8% (95% CI 0.1–1.7%) in the group of patients with routinely ordered head CT but without clinical deterioration. The following factors were statistically associated with need for intervention: use of anticoagulant or antithrombotic medication, fracture in middle meningeal artery territory, even a single point decrease in GCS score, increased headache, recurrent vomiting, neurological deficit, and finally, changes in repeat head CT.

Conclusions

In patients with minor head injuries, those without neurological deterioration have a very low risk of need for medical or surgical intervention. Routinely ordering repeat head CT scans in this group may not be routinely indicated.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Acknowledgements

We are thankful to Prof. Stephan Rinnert, M.D who reviewed and revised the manuscript for grammar and syntax.

Funding

The authors received no financial support for the research, authorship, or publication of this article.

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Authors and Affiliations

  1. Emergency Medicine Department, Health Science University Antalya Training and Research Hospital, Antalya, Turkey

    Yusuf Karanci

  2. Department of Emergency Medicine, Akdeniz University School of Medicine, Antalya, Turkey

    Cem Oktay

Authors
  1. Yusuf Karanci
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  2. Cem Oktay
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Corresponding author

Correspondence to Yusuf Karanci.

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Conflict of interest

Yusuf KARANCI and Cem OKTAY have no conflicts of interest. The manuscript is not under consideration for publication elsewhere.

Ethics approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Consent to participate

Informed consent was not obtained from all patients for inclusion in the study because of its retrospective, observational design.

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Karanci, Y., Oktay, C. Repeat CT after blunt head trauma and Glasgow Coma Scale score 13–15 without neurological deterioration is very low yield for intervention. Eur J Trauma Emerg Surg 48, 1069–1076 (2022). https://doi.org/10.1007/s00068-021-01642-y

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  • DOI: https://doi.org/10.1007/s00068-021-01642-y

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