TY - JOUR
T1 - Follow-up computerized tomography (CT) scans in moderate and severe head injuries
T2 - Correlation with Glasgow coma scores (GCS), and complication rate
AU - Lee, Thomas T.
AU - Aldana, P. R.
AU - Kirton, O. C.
AU - Green, B. A.
PY - 1997/1/1
Y1 - 1997/1/1
N2 - Background: The wide availability of computerized tomography (CT) scan has popularized its use in initial and follow-up evaluations of head trauma patients. Follow-up CT scans of clinically stable patients, however, may not provide additional information, but could potentially subject the patients to secondary injuries. The authors investigated the correlation between CT scans and Glasgow coma score (GCS), and complication rare during follow-up CT scans in an attempt to dissuade clinicians from obtaining unnecessary follow-up CT scans. Methods. The medical records of 180 patients with blunt head trauma were retrospectively reviewed. Only patients (117) with moderate and severe head injuries were included in the study. A total of 319 follow-up brain CT's for 94 patients were obtained. Results: The change in CT scans was compared to the GCS the day of the scan. These two variables were found to be positively correlated by Chi-square analysis (χ2 = 81.2; α < 0.001). CPP trend was found also be correlated with CT scan evolution by the Chi-square analysis (α < 0.001). When patients had unchanged or improved GCS, 73.1% had improved or the same CT appearance. When patients had a worse GCS, the CT was worse in 77.9%. A 16.9% (54/319) complication rate was documented during the follow-up scans (hemodynamic instability, increased intracranial pressure, desaturation, and agitation). This rare was higher in severe head trauma (GCS 3-8) patients than in moderate head injury (GCS 9-12) patients. Hemodynamic instability was the most common complication, which comprises 42.6% (23/54) of all complications. Conclusion: Because of the correlation between the CT scan appearance and the clinical status, as well as the detrimental effect of mobilizing critically ill patients, the authors urge the use of follow-up CT scans only in patients with clinical deterioration unexplained by ICP changes alone.
AB - Background: The wide availability of computerized tomography (CT) scan has popularized its use in initial and follow-up evaluations of head trauma patients. Follow-up CT scans of clinically stable patients, however, may not provide additional information, but could potentially subject the patients to secondary injuries. The authors investigated the correlation between CT scans and Glasgow coma score (GCS), and complication rare during follow-up CT scans in an attempt to dissuade clinicians from obtaining unnecessary follow-up CT scans. Methods. The medical records of 180 patients with blunt head trauma were retrospectively reviewed. Only patients (117) with moderate and severe head injuries were included in the study. A total of 319 follow-up brain CT's for 94 patients were obtained. Results: The change in CT scans was compared to the GCS the day of the scan. These two variables were found to be positively correlated by Chi-square analysis (χ2 = 81.2; α < 0.001). CPP trend was found also be correlated with CT scan evolution by the Chi-square analysis (α < 0.001). When patients had unchanged or improved GCS, 73.1% had improved or the same CT appearance. When patients had a worse GCS, the CT was worse in 77.9%. A 16.9% (54/319) complication rate was documented during the follow-up scans (hemodynamic instability, increased intracranial pressure, desaturation, and agitation). This rare was higher in severe head trauma (GCS 3-8) patients than in moderate head injury (GCS 9-12) patients. Hemodynamic instability was the most common complication, which comprises 42.6% (23/54) of all complications. Conclusion: Because of the correlation between the CT scan appearance and the clinical status, as well as the detrimental effect of mobilizing critically ill patients, the authors urge the use of follow-up CT scans only in patients with clinical deterioration unexplained by ICP changes alone.
KW - Blunt head trauma
KW - Cerebral perfusion pressure
KW - Complication
KW - Computerized tomography (CT) Glasgow coma score (GCS)
KW - Intracranial pressure;
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U2 - 10.1007/BF01411558
DO - 10.1007/BF01411558
M3 - Article
C2 - 9442218
AN - SCOPUS:0030687648
VL - 139
SP - 1042
EP - 1048
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
IS - 11
ER -