CT scanning and surgical treatment of 1551 head injured patients admitted to a regional neurosurgical unit.

Computed tomographic (CT) scans of 1551 recently head injured patients transferred to a regional neurosurgical unit (NSU) were reviewed. Some 90% of first scans were done outside normal working hours. More than a third of first scans were normal including a fifth of the patients who were in deep coma. Haematoma was found in 50%, contusion 28%, shearing injuries 13% and general swelling in 9%. In 22% the first scan led to urgent surgical evacuation of an intracranial haematoma. More than one scan was done in 41% of patients and more than two in 10%, making 2608 scans in all. Repeat scans were more often done when the first scan was abnormal. In only five of 554 patients (1%) whose first scan had been normal were contusions or haematomas seen on subsequent scans, and in none of these was surgery required. Of 997 patients whose first scan had been abnormal a new lesion (contusion, haematoma and/or infarction) was seen on a subsequent scan in 103 cases (10%). Surgery was required (for the first time), in 57 patients whose abnormal first scans had not indicated the necessity for surgery at that time. The implications of these and other findings for the scanning of recently head injured patients in general hospitals, as scanners become more widely available, are discussed in our accompanying paper on p. 88.