Beedkar Saurabh, Prasad G Lakshmi, Menon Girish
Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Surg Neurol Int. 2024 Sep 6;15:317. doi: 10.25259/SNI_376_2024. eCollection 2024.
Scheduled CT scan is a routine practice at many centers after traumatic brain injury (TBI), but it has been questioned by few authors. The majority of the studies are reported in mild TBI; however, no specific data exist for the same in moderate and severe TBI.
This was a single-center and 1-year prospective study. All cases with TBI who underwent scheduled repeat scans were included in the study. Patients who underwent emergency surgery after first computed tomography (CT) and those who expired before repeat CT were excluded from the study. Data included demographics, Glasgow coma scale (GCS) score, initial head CT findings, findings of repeat CT, and the need for any intervention (medical/surgical).
A total of 231 cases were analyzed. The mean time interval for the repeat CT was 7.8 h. One hundred and seventy-one patients underwent scheduled repeat CT (Group 1), 53 patients with GCS >13 were discharged from emergency before the repeat scan (Group 2), and seven cases underwent repeat CT before the scheduled time in view of clinical deterioration (Group 3). The mean age and gender did not vary significantly between the three groups. Mixed lesions predominated in all; however, the proportion significantly differed between groups. In Group 1, two patients required surgery; in Group 3, all patients required a significant change in treatment, whereas none deteriorated or required a repeat scan in Group 2.
In our study, the yield of routine repeat CT scans requiring surgery was 3.5%. Based on the results of our study and the observations from previous studies, we have proposed a few general working statements regarding indications for repeat CT scans in TBI.
在许多中心，创伤性脑损伤（TBI）后进行定期CT扫描是一种常规做法，但很少有作者对此提出质疑。大多数研究报道的是轻度TBI；然而，对于中度和重度TBI，尚无具体数据。
这是一项单中心、为期1年的前瞻性研究。所有接受定期重复扫描的TBI病例均纳入研究。首次计算机断层扫描（CT）后接受急诊手术的患者以及在重复CT检查前死亡的患者被排除在研究之外。数据包括人口统计学资料、格拉斯哥昏迷量表（GCS）评分、首次头部CT检查结果、重复CT检查结果以及任何干预措施（药物/手术）的必要性。
共分析了231例病例。重复CT检查的平均时间间隔为7.8小时。171例患者接受了定期重复CT检查（第1组），53例GCS>13的患者在重复扫描前从急诊科出院（第2组），7例因临床病情恶化在预定时间前接受了重复CT检查（第3组）。三组之间的平均年龄和性别差异无统计学意义。所有组中混合性病变均占主导；然而，各组之间的比例差异显著。在第1组中，2例患者需要手术；在第3组中，所有患者的治疗都需要显著改变，而第2组中无一例病情恶化或需要重复扫描。
在我们的研究中，需要手术的常规重复CT扫描的阳性率为3.5%。基于我们的研究结果和先前研究的观察结果，我们提出了一些关于TBI重复CT扫描适应证的一般工作声明。
