Utility of Head Computed Tomography Scans Prior to Outpatient Follow-up for Low-Risk Mild Traumatic Brain Injury.

Abstract

BACKGROUND\nNeurosurgeons are frequently consulted for traumatic brain injuries (TBI) resulting in intracranial hemorrhage (ICH). After inpatient confirmation of hemorrhage stability, outpatient head computed tomography (CT) is often performed to assess for hemorrhage resolution. Our objective was to assess the practice patterns and clinical utility of routine outpatient head CT scans for patients with mild-TBI (mTBI).\n\n\nMATERIALS AND METHODS\nA retrospective review was performed on all adult mTBI patients with ICH who presented to a level I trauma center over a four-year period. A combination of the patient s initial clinical evaluation and CT findings was used to identify mTBI patients at low risk for neurological deterioration and neurosurgical intervention. Findings from the outpatient follow-up clinical evaluation and head CT were assessed. Patients without outpatient follow-up within 3 months were excluded.\n\n\nRESULTS\nForty-nine patients met inclusion criteria for the study. Thirty-two had an outpatient head CT prior to their follow-up appointment. Twenty-one patients had at least one neurologic finding at the earliest follow-up appointment. All patients except those with a SDH had smaller or resolving ICH on outpatient CT scans. Seven patients with a SDH had unchanged or expanded hemorrhage on outpatient imaging. Of these seven, two had TBI-related hospitalizations, and one underwent neurosurgical intervention due to enlarging SDH.\n\n\nCONCLUSION\nRoutine outpatient head CT scans prior to follow-up for low-risk mTBI patients without a SDH appears to have limited clinical utility. In low-risk mTBI patients with a SDH, obtaining an outpatient head CT is reasonable to monitor for resolution.