Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia.
Ann Surg. 2011 Dec;254(6):1028-31. doi: 10.1097/SLA.0b013e318219727f.
To prospectively examine the clinical role of routine repeat computed tomographic scans of the brain (CTB) in patients with traumatic head injury.
The use of routine serial CTB after traumatic head injury is recommended by some authors, but remains controversial.
From March 2007 to October 2008, all patients with traumatic head injury admitted to the Royal Melbourne Hospital, a metropolitan, Level I trauma center, were prospectively studied. After the initial computed tomography brain scans, any subsequent CTBs were assessed and were recorded as being either "clinically indicated" or "routine" and ensuing medical and surgical management. Inpatient information was recorded and comparisons made according to indication for CTB, Glasgow Coma Scale, and management changes.
A total of 651 patients were admitted with traumatic head injury over the 20-month study period. Of those, 39 underwent immediate craniotomy/craniectomy and were excluded from analysis. Another 25 were excluded due to incomplete data, leaving 591 patients for analysis. Of the 591 assessed, 401 were discharged with no further computed tomography investigation. One hundred and ninety patients underwent a total of 305 repeat brain scans, of which 149 were clinically indicated, whereas 156 were obtained as a "routine" investigation with no deterioration in patients' neurological status. Of the repeated scans, 71 were improved, 169 were unchanged, and 64 were worse. None of the 156 patients who received a "routine" CTB required a change in management. The 149 CTB performed for clinical deterioration resulted in a change in management in 28 patients (19%). The patients who underwent "indicated" computed tomographic scans and subsequently required a change in management were on average younger (P < 0.001) and more severely head injured (P = 0.001) than the patients not requiring a change in management.
No patients from our cohort with a "routine" repeat CTB required a change in management. Given the costs and potential risks of routine repeat CTB, and lack of demonstrable benefit, the practice should be reconsidered. Repeat CTB is clearly indicated in patients with deteriorating neurological status, especially younger and more severely head-injured patients.
前瞻性研究颅脑创伤患者常规重复颅脑 CT 扫描（CTB）的临床作用。
一些作者建议对颅脑创伤后常规进行连续 CTB，但仍存在争议。
2007 年 3 月至 2008 年 10 月，前瞻性研究所有入住墨尔本皇家医院（大都市一级创伤中心）的颅脑创伤患者。初始颅脑 CT 扫描后，评估所有后续 CTB，并记录为“临床指征”或“常规”，以及随后的医疗和手术管理。记录住院信息，并根据 CTB 指征、格拉斯哥昏迷量表和管理变化进行比较。
在 20 个月的研究期间，共有 651 例颅脑创伤患者入院。其中 39 例立即行开颅术/去骨瓣减压术，被排除在分析之外。另有 25 例因数据不完整而被排除，591 例患者可用于分析。在 591 例评估患者中，401 例患者出院，未进行进一步 CT 检查。190 例患者共进行了 305 次重复颅脑扫描，其中 149 次为临床指征，而 156 次为“常规”检查，患者神经状态无恶化。在重复扫描中，71 例改善，169 例不变，64 例恶化。在接受“常规”CTB 的 156 例患者中，无一例需要改变治疗方案。因临床恶化而进行的 149 次 CTB 检查导致 28 例患者（19%）改变治疗方案。接受“指征性”CT 扫描并随后需要改变治疗方案的患者平均年龄较小（P < 0.001），且颅脑损伤更严重（P = 0.001），与不需要改变治疗方案的患者相比。
我们的队列中没有患者因“常规”重复 CTB 而需要改变治疗方案。鉴于常规重复 CTB 的成本和潜在风险，以及缺乏明显的益处，应重新考虑该做法。对于神经功能恶化的患者，尤其是年轻和颅脑损伤更严重的患者，重复 CTB 是明确指征。
