Routine Repeated CT Scans Not Required After Mild Head Trauma

When an initial computed tomography (CT) scan shows hemorrhaging within the brain after a mild head injury, decisions about repeated CT scanning should be based on the patient’s neurologic condition, according to a recent report.

The research was published in the January 2013 issue of Neurosurgery, the official journal of the Congress of Neurological Surgeons. The study questions the need for routinely obtaining repeated CT scans in patients with mild head trauma. “The available evidence indicates that it is unnecessary to schedule a repeat CT scan after mild head injury when patients are unchanged or improving neurologically,” according to the study by Dr. Saleh Almenawer and colleagues from McMaster University (Hamilton, Ontario, Canada.

In a review of their hospital’s trauma database, the researchers identified 445 adult patients with mild head injury who had evidence of intracranial hemorrhage (ICH) on an initial CT scan. In many trauma centers, it is standard practice to schedule a second CT scan within 24 hours after ICH is detected, to make sure that the bleeding has not progressed.

To evaluate the need for routine repeated scans, Dr. Almenawer and colleagues looked at how many patients needed surgery or other additional therapy, and whether the change in treatment was prompted by changes in the patients’ neurologic condition or based on the routine CT scan alone. (For patients whose neurologic condition deteriorated, CT was performed right away.)

Overall, 5.6% of the patients required a change in treatment after the second CT scan. Most of these patients underwent surgery (craniectomy) to relieve pressure on the brain. Nearly all patients who underwent further treatment developed neurological changes leading to immediate CT scanning. Only two patients had a change in treatment based only on routine repeated CT scans. Both of these patients received a drug (mannitol) to lessen intracranial pressure, instead of performing surgery.

Dr. Almenawer and colleagues extended the same modality to patients reported in 15 earlier series of CT scanning after mild head injury. Including the 445 new patients, the analysis included a total of 2,693 patients. Overall, 2.7% of patients had a change in management based on neurological changes. In contrast, just 0.6% had treatment alterations based on CT scans only.

Hemorrhaging within the brain is a potentially life-threatening condition, prompting routine repeated CT scans after even mild head injury. The researchers wrote, “Although CT scanners are very useful tools, in an era of diminishing resources and a need to justify medical costs, this practice needs to be evaluated.” Each scan also exposes the patient to radiation, contributing to increased cancer risk.

The new study questions the need for routine repeated CT scans as long as the patient’s neurologic condition is improving or stable. “In the absence of supporting data, we question the value of routine follow-up imaging given the associated accumulative increase in cost and risks,” Dr. Almenawer and coauthors concluded.

Neurologic examination is the “simple yet important” predictive factor leading to changes in treatment and guiding the need for repeat CT scanning after mild head injury, the researchers added. The investigators stressed that their research do not necessarily apply to patients with more severe head injury.


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