Complicated Mild Traumatic Brain Injury and the Need for Imaging Surveillance
Abstract Objective to evaluate the need for repeat head CT in patients with complicated mild traumatic brain injury (cmTBI) determined non-operative after the first head CT Methods 380 patients with mild TBI and a positive head CT not needing surgery were included. Changes between first and second h...
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| Veröffentlicht in: | World neurosurgery 2017-09, Vol.105, p.265-269 |
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| creator | Stippler, Martina, MD, MS Liu, Jingyi, BA Motiei-Langroudi, Rouzbeh, MD Voronovich, Zoya, MD Yonas, Howard, MD Davis, Roger B., ScD |
| description | Abstract Objective to evaluate the need for repeat head CT in patients with complicated mild traumatic brain injury (cmTBI) determined non-operative after the first head CT Methods 380 patients with mild TBI and a positive head CT not needing surgery were included. Changes between first and second head CT were categorized as decreased, increased or stable. Results Three patients required neurosurgical intervention (0.8%) after the second CT. There were no significant differences in demographics including age, gender, alcohol consumption, anticoagulation status, time between first and second CT, GCS at admission and discharge, and incidence of SAH, EDH, contusion or skull fractures between the operated and non-operated groups. All patients in the operated group had SDH compared to 40.8% in the non-operated group (p = 0.07). All operated patients demonstrated symptoms of neurological worsening after initial head CT, compared to 2.7% in the non-operated group (p |
| doi_str_mv | 10.1016/j.wneu.2017.05.008 |
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Changes between first and second head CT were categorized as decreased, increased or stable. Results Three patients required neurosurgical intervention (0.8%) after the second CT. There were no significant differences in demographics including age, gender, alcohol consumption, anticoagulation status, time between first and second CT, GCS at admission and discharge, and incidence of SAH, EDH, contusion or skull fractures between the operated and non-operated groups. All patients in the operated group had SDH compared to 40.8% in the non-operated group (p = 0.07). All operated patients demonstrated symptoms of neurological worsening after initial head CT, compared to 2.7% in the non-operated group (p<0.001). Moreover, patients who demonstrated neurological worsening were more likely to demonstrate increased intracranial bleeding on repeat head CT, while patients who did not demonstrate neurological worsening were more likely to demonstrate decreased or stable intracranial bleeding (p= 0.04). Conclusions Routine repeat head CT in cmTBI patients is very low yield to predict need for delayed surgical intervention. Instead, serial neurological examination and observation over the first 8 hours after the injury is recommended. A second CT scan should be obtained only in patients who have neurological worsening.</description><identifier>ISSN: 1878-8750</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2017.05.008</identifier><identifier>PMID: 28502689</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Brain Concussion - complications ; Brain Concussion - diagnostic imaging ; Brain Concussion - surgery ; CT scan ; Female ; Glasgow Coma Scale ; Head - diagnostic imaging ; Humans ; Imaging ; Male ; Middle Aged ; Mild ; Neurosurgery ; Retrospective Studies ; Tomography Scanners, X-Ray Computed ; Traumatic brain injury</subject><ispartof>World neurosurgery, 2017-09, Vol.105, p.265-269</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-6b78f4ba110702d5c48b5e58a75381e565644aff46012d1f6ade8e3a99cf701a3</citedby><cites>FETCH-LOGICAL-c411t-6b78f4ba110702d5c48b5e58a75381e565644aff46012d1f6ade8e3a99cf701a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.wneu.2017.05.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28502689$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stippler, Martina, MD, MS</creatorcontrib><creatorcontrib>Liu, Jingyi, BA</creatorcontrib><creatorcontrib>Motiei-Langroudi, Rouzbeh, MD</creatorcontrib><creatorcontrib>Voronovich, Zoya, MD</creatorcontrib><creatorcontrib>Yonas, Howard, MD</creatorcontrib><creatorcontrib>Davis, Roger B., ScD</creatorcontrib><title>Complicated Mild Traumatic Brain Injury and the Need for Imaging Surveillance</title><title>World neurosurgery</title><addtitle>World Neurosurg</addtitle><description>Abstract Objective to evaluate the need for repeat head CT in patients with complicated mild traumatic brain injury (cmTBI) determined non-operative after the first head CT Methods 380 patients with mild TBI and a positive head CT not needing surgery were included. Changes between first and second head CT were categorized as decreased, increased or stable. Results Three patients required neurosurgical intervention (0.8%) after the second CT. There were no significant differences in demographics including age, gender, alcohol consumption, anticoagulation status, time between first and second CT, GCS at admission and discharge, and incidence of SAH, EDH, contusion or skull fractures between the operated and non-operated groups. All patients in the operated group had SDH compared to 40.8% in the non-operated group (p = 0.07). All operated patients demonstrated symptoms of neurological worsening after initial head CT, compared to 2.7% in the non-operated group (p<0.001). Moreover, patients who demonstrated neurological worsening were more likely to demonstrate increased intracranial bleeding on repeat head CT, while patients who did not demonstrate neurological worsening were more likely to demonstrate decreased or stable intracranial bleeding (p= 0.04). Conclusions Routine repeat head CT in cmTBI patients is very low yield to predict need for delayed surgical intervention. Instead, serial neurological examination and observation over the first 8 hours after the injury is recommended. A second CT scan should be obtained only in patients who have neurological worsening.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Brain Concussion - complications</subject><subject>Brain Concussion - diagnostic imaging</subject><subject>Brain Concussion - surgery</subject><subject>CT scan</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Head - diagnostic imaging</subject><subject>Humans</subject><subject>Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mild</subject><subject>Neurosurgery</subject><subject>Retrospective Studies</subject><subject>Tomography Scanners, X-Ray Computed</subject><subject>Traumatic brain injury</subject><issn>1878-8750</issn><issn>1878-8769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtv1DAUhS0EolXpH2CBvGQz4d4kfkRCSDDiMVILi5a15bFvikMeg50Uzb_H0ZQuWODN9eKco3u_w9hLhAIB5Zuu-D3SUpSAqgBRAOgn7By10hutZPP08S_gjF2m1EF-FdZaVc_ZWakFlFI35-x6Ow2HPjg7k-fXoff8NtplsHNw_EO0YeS7sVvikdvR8_kH8a-Uhe0U-W6wd2G84zdLvKfQ93Z09II9a22f6PJhXrDvnz7ebr9srr593m3fX21cjThv5F7ptt5bRFBQeuFqvRcktFWi0khCClnXtm1rCVh6bKX1pKmyTeNaBWirC_b6lHuI06-F0myGkBytS9C0JIO6aRC0FJCl5Unq4pRSpNYcYhhsPBoEs5I0nVlJmpWkAWEyyWx69ZC_7Afyj5a_3LLg7UlA-cr7QNEkFygT8CGSm42fwv_z3_1jd30Ycwv9TzpS6qYljpmfQZNKA-Zm7XKtElUFspF19QdXM5h5</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Stippler, Martina, MD, MS</creator><creator>Liu, Jingyi, BA</creator><creator>Motiei-Langroudi, Rouzbeh, MD</creator><creator>Voronovich, Zoya, MD</creator><creator>Yonas, Howard, MD</creator><creator>Davis, Roger B., ScD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170901</creationdate><title>Complicated Mild Traumatic Brain Injury and the Need for Imaging Surveillance</title><author>Stippler, Martina, MD, MS ; Liu, Jingyi, BA ; Motiei-Langroudi, Rouzbeh, MD ; Voronovich, Zoya, MD ; Yonas, Howard, MD ; Davis, Roger B., ScD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-6b78f4ba110702d5c48b5e58a75381e565644aff46012d1f6ade8e3a99cf701a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Brain Concussion - complications</topic><topic>Brain Concussion - diagnostic imaging</topic><topic>Brain Concussion - surgery</topic><topic>CT scan</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Head - diagnostic imaging</topic><topic>Humans</topic><topic>Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mild</topic><topic>Neurosurgery</topic><topic>Retrospective Studies</topic><topic>Tomography Scanners, X-Ray Computed</topic><topic>Traumatic brain injury</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stippler, Martina, MD, MS</creatorcontrib><creatorcontrib>Liu, Jingyi, BA</creatorcontrib><creatorcontrib>Motiei-Langroudi, Rouzbeh, MD</creatorcontrib><creatorcontrib>Voronovich, Zoya, MD</creatorcontrib><creatorcontrib>Yonas, Howard, MD</creatorcontrib><creatorcontrib>Davis, Roger B., ScD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stippler, Martina, MD, MS</au><au>Liu, Jingyi, BA</au><au>Motiei-Langroudi, Rouzbeh, MD</au><au>Voronovich, Zoya, MD</au><au>Yonas, Howard, MD</au><au>Davis, Roger B., ScD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complicated Mild Traumatic Brain Injury and the Need for Imaging Surveillance</atitle><jtitle>World neurosurgery</jtitle><addtitle>World Neurosurg</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>105</volume><spage>265</spage><epage>269</epage><pages>265-269</pages><issn>1878-8750</issn><eissn>1878-8769</eissn><abstract>Abstract Objective to evaluate the need for repeat head CT in patients with complicated mild traumatic brain injury (cmTBI) determined non-operative after the first head CT Methods 380 patients with mild TBI and a positive head CT not needing surgery were included. Changes between first and second head CT were categorized as decreased, increased or stable. Results Three patients required neurosurgical intervention (0.8%) after the second CT. There were no significant differences in demographics including age, gender, alcohol consumption, anticoagulation status, time between first and second CT, GCS at admission and discharge, and incidence of SAH, EDH, contusion or skull fractures between the operated and non-operated groups. All patients in the operated group had SDH compared to 40.8% in the non-operated group (p = 0.07). All operated patients demonstrated symptoms of neurological worsening after initial head CT, compared to 2.7% in the non-operated group (p<0.001). Moreover, patients who demonstrated neurological worsening were more likely to demonstrate increased intracranial bleeding on repeat head CT, while patients who did not demonstrate neurological worsening were more likely to demonstrate decreased or stable intracranial bleeding (p= 0.04). Conclusions Routine repeat head CT in cmTBI patients is very low yield to predict need for delayed surgical intervention. Instead, serial neurological examination and observation over the first 8 hours after the injury is recommended. A second CT scan should be obtained only in patients who have neurological worsening.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28502689</pmid><doi>10.1016/j.wneu.2017.05.008</doi><tpages>5</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Brain Concussion - complications Brain Concussion - diagnostic imaging Brain Concussion - surgery CT scan Female Glasgow Coma Scale Head - diagnostic imaging Humans Imaging Male Middle Aged Mild Neurosurgery Retrospective Studies Tomography Scanners, X-Ray Computed Traumatic brain injury |
| title | Complicated Mild Traumatic Brain Injury and the Need for Imaging Surveillance |
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