Utility of routine follow-up head CT scanning after mild traumatic brain injury: a systematic review of the literature
- Martina Stippler1,
- Carl Smith2,
- A Robb McLean2,
- Andrew Carlson1,
- Sarah Morley3,
- Cristina Murray-Krezan4,
- Jessica Kraynik5,
- George Kennedy2
- 1Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
- 2Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA
- 3Health Sciences Library and Informatics Center, University of New Mexico, Albuquerque, New Mexico, USA
- 4Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico, USA
- 5School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
- Correspondence to Dr Martina Stippler, Assistant Professor of Neurological Surgery, Director of Neurotrauma, University of New Mexico, Department of Neurological Surgery, 1 University of New Mexico, MSC10 5615, Albuquerque, NM 87131-0001, USA;
Contributors Manuscript concept: MS. All authors contributed to the development and editing of the manuscript.
- Accepted 9 December 2011
- Published Online First 3 February 2012
Objective To evaluate the efficacy of routine follow-up CT scans of the head after complicated mild traumatic brain injury (TBI).
Methods 74 English language studies published from 1999 to February 2011 were reviewed. The papers were found by searching the PubMed database using a combination of keywords according to Cochrane guidelines. Excluding studies with missing or inappropriate data, 1630 patients in 19 studies met the inclusion criteria: complicated mild TBI, defined as a GCS score 13–15 with abnormal initial CT findings and the presence of follow-up CT scans. For these studies, the progression and type of intracranial haemorrhage, time from trauma to first scan, time between first and second scans, whether second scans were obtained routinely or for neurological decline and the number of patients who had a neurosurgical intervention were recorded.
Results Routine follow-up CT scans showed hemorrhagic progression in 324 patients (19.9%). Routine follow-up head CT scans did not predict the need for neurosurgical intervention (p=0.10) but a CT scan of the head performed for decline in status did (p=0.00046). For the 56 patients (3.4%) who declined neurologically, findings on the second CT scan were worse in 38 subjects (67%) and unchanged in the rest. Overall, 39 patients (2.4%) underwent neurosurgical intervention.
Conclusion Routine follow-up CT scans rarely alter treatment for patients with complicated mild TBI. Follow-up CT scans based on neurological decline alter treatment five times more often than routine follow-up CT scans.
- Complicated mild traumatic brain injury
- repeat head CT
- systematic review
- emergency department management
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.