Department of Trauma and Critical Care, 6528Einstein Healthcare Network, Philadelphia, PA, USA.
Department of Surgery, Crozer Health, Upland, PA, USA.
Am Surg. 2022 Aug;88(8):1946-1953. doi: 10.1177/00031348221075763. Epub 2022 Feb 27.
Patients presenting with traumatic intracranial hemorrhage (ICH) routinely undergo repeat head Computed Tomography (CT) scans with the goal of identifying progressing hemorrhage early and providing timely intervention. Glasgow Coma Scale (GCS) score and Abbreviated Injury Score (AIS) are typically used to grade the severity of traumatic brain injury (TBI) and triage subsequent management. However, most patients receive a repeat head CT scan within 6 hours of the initial insult, regardless of these clinical scores. We investigated the yield of a repeat CT scan for mild blunt TBI (GCS 13-15, AIS 1-2).
This was a single-center retrospective chart review at a level 1 trauma center between 2009 and 2019. Our primary outcome was medical or surgical intervention directly resulted from change in CT head findings. We used multivariate regression to identify predictors of surgical and medical intervention.
234 mild TBI patients met inclusion criteria. 33.7% of all patients had worsening ICH. 7.7% of patients required a surgical intervention, and 27.4% received a medical intervention. Multivariate analysis found that a decline in GCS (OR 8.64), and polytrauma (Injury Severity Score >15; OR 3.32) predicted surgical intervention. Worsening ICH did not predict surgical or medical intervention. Patients requiring medical intervention were more likely to have a decline in GCS (OR 2.53, P = .02) and be older (age >65, OR 2.06, P = .02).
In the population of blunt traumatic injury, worsening ICH did not predict surgical or medical intervention. Routine repeat imaging for this population is low yield, and clinical exam should guide the decision to reimage.
创伤性颅内出血（ICH）患者通常会进行多次头部计算机断层扫描（CT）检查，目的是早期识别进展性出血并及时进行干预。格拉斯哥昏迷评分（GCS）和简明损伤评分（AIS）通常用于分级创伤性脑损伤（TBI）的严重程度，并对后续管理进行分诊。然而，大多数患者在初次损伤后 6 小时内会接受重复头部 CT 扫描，无论这些临床评分如何。我们研究了轻度钝性 TBI（GCS 13-15，AIS 1-2）重复 CT 扫描的效果。
这是 2009 年至 2019 年在一家 1 级创伤中心进行的单中心回顾性图表审查。我们的主要结局是直接由 CT 头部发现的变化而导致的医疗或手术干预。我们使用多变量回归来识别手术和医疗干预的预测因素。
234 例轻度 TBI 患者符合纳入标准。所有患者中有 33.7%出现 ICH 加重。7.7%的患者需要手术干预，27.4%的患者接受了药物治疗。多变量分析发现 GCS 下降（OR 8.64）和多发伤（损伤严重程度评分>15；OR 3.32）预测手术干预。ICH 恶化并未预测手术或药物干预。需要药物治疗的患者更有可能出现 GCS 下降（OR 2.53，P =.02）和年龄较大（>65 岁，OR 2.06，P =.02）。
在钝性创伤性损伤人群中，ICH 恶化并未预测手术或药物干预。对该人群进行常规重复成像效果不佳，临床检查应指导重新成像的决策。
