Timing of repeated head computerised tomography and its impact on the management of patients with moderate and severe traumatic brain injury (TBIS)

ABSTRACT
The purpose of this prospective study over 100 patients who were admitted to surgical emergency unit was to
define the indications, the timing and the frequency of repeated head computerized tomography (CT) scan in
patients with moderate and severe traumatic brain injuries (TBIs) and to verify its impact on the management of
those patients. we found that Performing an initial early CT brain within 2 hours interval from onset of trauma
had a significance in comparison to 4 hours and 6 hours interval, none of the follow up CTs done upon
improvement of GCS show any changes, more than half of patients who show new changes or progression of
lesions in their follow up CT did it due to deteriorated GCS, the follow up CT done routinely showed progression
or new changes in around 70 % of the patients and affected the management in 60% of patients, the majority of
the follow up CT at which medical management was done (n=40) was arranged at 12 hours interval from the
initial CT done (30%) followed by those arranged at 6 hours (25%) and at 4 hours (22%), while follow up CT at
which surgical intervention was done (n=21) was those arranged at 4 hours interval from the initial CT done
(28%) followed by those arranged at 12 hours (24%) and 24 hours (24%).
Keywords: Computerised tomography, TBIS, GCS, trauma, patients

REFERENCES

1. Aaron G. Filler: The History, Development and Impact of Computed Imaging in Neurological Diagnosis and Neurosurgery: CT, MRI, and DTI Internet Journal of Neurosurgery 2010/07.
2. Brown CV, Zada G, Salim A, et al. Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury. J Trauma.2007; 62:1339-1345.
3. Figg RE, Burry TS, VanderKolk WE. Clinical efficacy of serial computed tomographic scanning in severe closed head injury patients. J Trauma. 2003; 55:1061-1064.
4. Kaups KL, Davis JW, Parks SN. Routinely repeated computed tomography after blunt head trauma: does it benefit patients? J Trauma. 2004; 56:475– 481.
5. Kido DK, Cox C, Hamill RW, et al. Traumatic brain injuries: predictive usefulness of CT. Radiology 1992; 182:777–81.
6. Lancet Neurology. "Role of repeat CT scans in the management of traumatic brain injury". The Lancet August 2012; vol7 (8).P.651.
7. Lee TT, Aldana PR, Kirton OC, et al. Follow-up computerized tomography (CT) scans in moderate and severe head injuries: correlation with Glasgow Coma Scores (GCS), and complication rate. Acta Neurochir (wien).1997; 139:1042-1048. .
8. Muhammad Sohail Umerani , Asad Abbas, Saqib Kamran Bakhshi, et al. Evolving  brain lesions in the follow up CT scans 12 hours after traumatic brain injury. Journal of Acute Disease 2016; 5(2): 150–153.
9. Narayan RK, Maas AI, Servadei F, et al. Traumatic Intracerebral Hemorrhage Study Group. Progression of traumatic intracerebral hemorrhage: a prospectiveobservational study. J Neurotrauma. 2008; 25:629-639.
10. Oertel M, Kelly DF, McArthur D, et al. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg. 2002; 96:109-116.
11. Ramesh S, Doddamani, Sunil K. Gupta, Navneet Singla, Sandeep Mohindra, Paramjeet Singh. "Role of repeat CT scans in the management of traumatic brain injury". The Indian journal of Neurotrauma June 2012, Vol.9 (1)33-39.
12. Reinus WR, Zwemer FL, Jr., Fornoff JR. Prospective optimization of patient selection for emergency cranial computed tomography: univariate and multivariate analyses. Invest Radiol 1996; 31:101–08.
13. Servadei F, Nanni A, Nasi MT, et al. Evolving brain lesions in the first 12 after head injury: analysis of 37 comatose patients. Neurosurgery. 1995; 37:899-907.
14. Sifri ZC, Livingston DH, Lavery RF, et al. Value of repeat cranial computed axial tomography scanning in patients with minimal head injury. AmJSurg.2004; 187:338-342. .
15. Smith JS, Chang EF, Rosenthal G, et al. The role of early follow-up computed tomography imaging in the management of traumatic brain injury patients with intracranial hemorrhage. J Trauma. 2007; 63:75-82.
16. Sateesh Pujari and Estari Mamidala (2015). Anti-diabetic activity of Physagulin-F isolated
    from Physalis angulata fruits. The Ame J Sci & Med Res, 2015,1(1):53-60.
    doi:10.17812/ajsmr2015113.
17. Stein SC, Spettell C, Young G, et al. Delayed and progressive brain injury in closed-head trauma: radiological demonstration. Neurosurgery 1993; 32:25– 30; discussion 30 –31.
18. Velmahos GC, Gervasini A, Petrovick L, et al. Routine repeat head
19. CT for minimal head injury is unnecessary. J Trauma. 2006; 60:494–501.
20. Wang MC, Linnau KF, Tirschwell DL, et al. Utility of repeat head computed tomography after blunt head trauma: a systematic review. J Trauma. 2006; 61:226-233.
21. Yamaki T, Hirakawa K, Ueguchi T, et al. Chronological evaluation of acute traumatic intracerebral haematoma. ActaNeurochir (Wien). 1990; 103:112-115.