The clinical efficacy of repeat brain computed tomography in patients with traumatic intracranial haemorrhage within 24 hours after blunt head injury.

摘要

This study was performed to determine the usefulness of repeated brain computed tomography (CT) within 24 hours of blunt head trauma in patients with traumatic intracranial haemorrhages (ICH) and who were initially treated nonsurgically. Factors associated with the worsening of lesions on repeat CT were evaluated. Medical records of all blunt head trauma patients with traumatic ICH admitted to our hospital from January 2003 to December 2006 were retrospectively reviewed. Patients older than 16 years of age with an initial Glasgow Coma Scale (GCS) of 8 or greater were included. From the results of the repeat CT, patients were categorized as Group 1 (improved or unchanged condition) or Group 2 (worsened condition). A total of 168 patients (mean age of 44.8 +/- 19.2; mean admission GCS of 13.42 +/- 2.07; male to female ratio 2.1:1) were included. In 161 patients, repeat CT was obtained on a routine basis. In the remaining 7, it was prompted by a worsening neurological condition. The mean time from initial to repeat CT was 10.10 +/- 7.25 hours. Based on the results of the repeat CT, 108 patients were included in Group 1 and 60 in Group 2. The mean initial GCS was lower in patients from Group 2 versus those from Group 1 (11.9 +/- 2.6 compared with 14.3 +/- 0.96; p < 0.001). After repeat CT, 28 (47%) of the patients in Group 2 underwent neurosurgical interventions. Of the 28 surgically treated patients from Group 2, 6 (10%) exhibited neurological worsening and 22 (37%) appeared neurologically stable. According to our data, we suggest that routine repeat CT within 24 hours after blunt head trauma might minimize potential neurological deterioration in patients with either a GCS lower than 12 or with an epidural haematoma or multiple lesions as indicated on initial CT.