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No need for routine repeated CT scans after mild head trauma, reports neurosurgery
Date:1/3/2013

an. Most of these patients underwent surgery (craniectomy) to relieve pressure on the brain. Nearly all patients who underwent further treatment developed neurological changes leading to immediate CT scanning.

Just two patients had a change in treatment based solely on routine repeated CT scans. Both of these patients received a drug (mannitol) to reduce intracranial pressure, rather than surgery

Decisions on CT Scans Can Be Based on Neurological Status

Dr. Almenawer and colleagues extended the same method to patients reported in 15 previous studies of CT scanning after mild head injury. Including the 445 new patients, the analysis included a total of 2,693 patients. Overall, 2.7 percent of patients had a change in management based on neurological changes. In contrast, just 0.6 percent had treatment changes based on CT scans only.

Bleeding within the brain is a potentially life-threatening condition, prompting routine repeated CT scans after even mild head injury. The researchers write, "Although CT scanners are very useful tools, in an era of diminishing resources and a need to justify medical costs, this practice needs to be evaluated." Each scan also exposes the patient to radiation, contributing to increased cancer risk.

The new study questions the need for routine repeated CT scans, as long as the patient's neurological condition is improving or stable. "In the absence of supporting data, we question the value of routine follow-up imaging given the associated accumulative increase in cost and risks," Dr. Almenawer and coauthors conclude.

Neurological examination is the "simple yet important" predictive factor leading to changes in treatment and guiding the need for repeat CT scanning after mild head injury, the researchers add. They emphasize that their findings don't necessarily apply to patients with more severe head injury.


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Contact: Connie Hughes
Connie.Hughes@wolterskluwer.com
646-674-6348
Wolters Kluwer Health
Source:Eurekalert

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