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Mild Traumatic Brain Injury: The Feasibility of Reducing Repetitive Head CT Scans in Stable Patients

Creative Commons 'BY' version 4.0 license

Introduction: Traumatic brain injuries (TBI) are a leading cause of mortality and morbidity. The Glasgow Coma Scale (GCS) is a clinical TBI severity grading system. CT scanning has also become a sensitive diagnostic tool in assessing TBIs. Currently, there is a widely varied practice in evaluation of patients with mild TBIs. We hypothesize that patients with an initially positive head CT and stable GCS (15) are less likely to have positive repeat CTs than patients who’s GCS has dropped below 15.

Methods: A 5 year retrospective analysis was done (Jan 2007-Dec 2011). Data points included ISS, ICU LOS, Hospital LOS, initial GCS, first head CT scan, lowest GCS between scans, and treatment after 2nd CT. Positive CT findings were considered an increase in contusion, bleed, edema, midline shift, or a new bleed.

Results: In 369 patients, those with a stable GCS (15) were less likely to have a positive repeat CT scan than patients who whose GCS dropped (12.9% vs. 24.9%, p<.01). They also tended to require less Interventions (0.8% vs. 4.0% , p=0.09). Unchanged patients were more likely to have a lower ISS (14 vs. 17, p<.01), ICU LOS (2 vs. 3 days, P<.01), and Hospital LOS ( 4 vs. 6, P<.01).

Conclusion: CT scans are a rapid, non-invasive diagnostic tool that can accurately diagnose a patient’s intracranial status. Our study shows that most patients who have initially positive CT scans and maintain a stable GCS of 15 can still safely forego the cost and radiation exposure of repeated scans.

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