Eliminating unnecessary routine head CT scanning in neurologically intact mild traumatic brain injury patients: implementation and evaluation of a new protocol

Journal of Neurosurgery
Seema P AnandalwarZiad C Sifri

Abstract

OBJECTIVE The utility of routine repeat head CT (HCT) scans in the management of minimal head injury (MHI) patients with an intracranial hemorrhage (ICH) has been questioned in multiple studies. All these studies analyzed this by obtaining a repeat HCT study, and none examined the effects of eliminating these routine HCT studies in neurologically intact patients. The authors' institution implemented a new "Neurologic Observation without Repeat HCT" (NORH) protocol with no repeat HCT scanning for patients admitted for MHI and ICH whose neurological status was maintained or improved to a Glasgow Coma Scale score of 15 at 24 hours after admission. This purpose of this study was to assess the outcomes and safety of this novel protocol. METHODS Records of patients who sustained blunt trauma MHI and an ICH and/or skull fracture on initial HCT between January 1, 2009, and December 31, 2012, were retrieved from the trauma registry of a Level I trauma center. The authors analyzed 95 patients in whom the NORH protocol was followed. Outcome measures included death, emergency department readmission, neurosurgical intervention, delayed repeat HCT, and length of stay. RESULTS The NORH protocol was followed for 95 patients; 83% of the patient...Continue Reading

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Citations

Jan 19, 2017·The Journal of Trauma and Acute Care Surgery·Paul R LewisSteven R Shackford
Mar 4, 2020·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Laura UccellaCesare Zoia
Jun 17, 2020·Trauma Surgery & Acute Care Open·Abid D KhanRichard P Gonzalez
Jan 25, 2020·AJNR. American Journal of Neuroradiology·A L CallenL P Sugrue
Jun 4, 2021·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Sophie-Charlott SeidenfadenMorten Thingemann Bøtker
Oct 13, 2020·The American Journal of Emergency Medicine·Jennifer M SingletonCarlo L Rosen

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Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.