1. 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
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