Publication:

Role of repeat neuroimaging in complicated mild traumatic brain injury: a single centre study

Background Patients with mild traumatic brain injury (TBI) and positive initial CT brain findings undergo routine repeat CT brain for follow-up usually after 48 hours as a Standard of care. Use of repeat routine neuro imaging is controversial in mild TBI. We hypothesized that in patients with mild TB I repeat neuro imaging of the brain would not alter the outcome or patient’s care. Aims and objectives were to evaluate the role of repeat CT brain in patients with complicated mild TBI (c-mild TBI) who were determined non-surgical medical line of management at the time of admission.

Methods It is a hospital based prospective observational single centre study. Clinical and demographic data including age, gender, admission and discharge GCS and timing of the first and second CT brain of the patients included in the study were recorded on pre-designed and pre-tested proforma. department of neurosurgery, government Mohan Kumaramangalam medical college hospital, Salem-01, Tamil Nadu, India.

Results Out of 552 patients, our study found that 46 (8.33%) patients had neurological deterioration in the form of drop in GCS, change in pupillary size, increased focal deficit, seizures or raised ICP symptoms, 94 (17.02%) patients had radiological progression in the form of increase in size of hematoma or edema and out of which only 21 (3.8%) patients underwent surgical intervention following second CT and all the patients who underwent surgical intervention had clinical neurological deterioration.

Conclusions For patients with c-mild TBI a repeat CT brain should be obtained only in patients who have neurological worsening and serial neurological examination and observation after the injury is recommended. With this approach, patients who need delayed neurosurgical intervention can be identified while unnecessary imaging procedures can be avoided.