Low Utility and Yield of Routine Outpatient CT Imaging in Patients With Mild Traumatic Brain Injury and Intracranial Hemorrhage.

OBJECTIVE AND BACKGROUND

This study aims to better characterize the utility of CT scan imaging when seeing mild traumatic brain injury (TBI) patients managed non-operatively in a clinic. The benefit of routinely scheduling outpatient head CT for patients discharged with mild TBI and intracranial hemorrhage (ICH) remains unclear. Unselective imaging increases cost, scanner demand, and cumulative radiation exposure.

METHODS

We performed a retrospective cohort study of 100 consecutive adults with mild TBI (Glasgow coma scale (GCS) 13-15) and non‑operative ICH who were admitted between January 2021 and December 2022, returned to our neurosurgery clinic one to four weeks after discharge, and underwent protocol‑driven follow‑up CT. Demographics, injury characteristics, inpatient course, clinic findings, and CT results were abstracted. Radiographic progression (new hemorrhage or ≥25% volume increase) was the primary outcome. Univariate tests and stepwise multivariable logistic regression explored predictors (p < 0.05).

RESULTS

The mean age was 53.8 ± 20.2 years; 63/100 (63 %) were men. Subdural hematoma occurred in 38/100 (38%), contusion in 20/100 (20%), and epidural hematoma in 7/100 (7%). At the clinic review, 37/100 (37%) reported persistent or new symptoms, and 4/100 (4%) had a new focal neurological deficit. Follow‑up CT demonstrated radiographic progression in 4/100 (4%); only 1/100 (1%) required surgical evacuation of a chronic subdural hematoma. Anticoagulation 6/100 (6%), antiplatelet therapy 18/100 (18%), hemorrhage subtype, and inpatient enlargement were not associated with delayed progression on univariate (all p > 0.20) or multivariable analysis (area under the receiver operating characteristic curve (AUROC) 0.58).

CONCLUSION

In clinically stable mild‑TBI patients with ICH, routine outpatient CT changed management in only 1% of cases. A symptom- or risk‑based imaging strategy appears safe and could markedly reduce radiation exposure, scanner congestion, and cost.