Necessity of Monitoring after Negative Head CT in Acute Head Injury Objectives Patients with head injury n=3,023 To evaluate the incidence of delayed complications in acute head injury (HI) patients with an initial normal head computed tomography (CT) Acute traumatic lesion on CT n=579 (19.2%) Acute head CT Hospital death unrelated to head injury n=1 (0.04%) Methods n=2,444 (80.8%) No acute lesions on CT 3,023 consecutive patients with an acute HI underwent head CT at the Emergency Department (ED) of Tampere University Hospital Patients with a normal head CT were selected (n=2,444, 80.8 %) The medical records were reviewed to identify the individuals with a serious complication related to the primary HI A repeated head CT in the hospital ward, death, or return to the ED were indicative of a possible complication The time window considered was the following 72 hours after the primary head CT No need for returning to the hospital was considered a good outcome Hospital death within 72 hours of head CT n=10 (0.4%) Admission to hospital ward n=632 (25.9%) Discharged home/ health center n=1,811 (74.1%) Death within 72 hours of head CT n=10 (0.4%) Repeated head CT within 72h of primary CT n=46 (1.9%) Returned to ED within 72 hours of head CT n=27 (1.1%) No acute traumatic lesions on CT n=45 (1.8%) Results Acute head CT n=12 (0.5%) 74.1% (n=1,1811) of the CT-negatives were discharged home 1.1% (n=27) of these patients returned to ED within 72 hours post-CT A repeated head CT was performed on 12 (44.4%) of the returned patients and none of the scans revealed an acute lesion 25.9% (n=632) of the CT-negative patients were admitted to the hospital A repeated head CT was performed in 46 (7.3%) of the admitted patients within 72 hours In the repeated CT sample, only one (0.2%) patient had an traumatic intracranial lesion which did not need any kind of intervention The overall complication rate was 0.04% (no severe complications) Death unrelated to head injury n=10 (0.4%) n=1 (0.04%) Acute traumatic lesion on CT No acute traumatic lesions on CT n=12 (0.5%) Death unrelated to head injury n=10 (0.4%) n=1 (0.04%) Complication rate in those with an initial negative head CT (small contusion) Life-threatening complications or complications needing surgery n=0 (0%) Conclusion The probability of delayed life-threatening complications was negligible when the primary CT scan revealed no acute traumatic lesions Routine repeated CT scanning or observation is not warranted when the primary CT scan is negative Our findings suggest that all head trauma patients with negative CT scans can be discharged without observation Harri Isokuortti BM1 Teemu Luoto MD2 Anneli Kataja MD3 Antti Brander MD, PhD3 Jari Siironen MD, PhD4 Suvi Liimatainen MD, PhD2 Grant L. Iverson PhD5 Aarne Ylinen MD, PhD1,6 Juha Öhman MD, PhD2 1Department of Neurological Sciences, University of Helsinki, Helsinki, Finland 2Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland 3Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere 4Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland 5Department of Physical Medicine and Rehabilitation, Harvard Medical School; & Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA 6Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland For more info and contacts: